Comparison of physician-delivered models of virtual and home-based in-person care for adults in the last 90 days of life with cancer and terminal noncancer illness during the COVID-19 pandemic.

Autor: Akhter R; Department of Medicine, Sinai Health System, Toronto, ON, Canada., Stukel TA; ICES, Toronto and Ottawa, ON, Canada.; Insitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada., Chung H; ICES, Toronto and Ottawa, ON, Canada., Bell CM; Department of Medicine, Sinai Health System, Toronto, ON, Canada.; Insitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.; Department of Medicine, University of Toronto, Toronto, ON, Canada., Detsky AS; Department of Medicine, Sinai Health System, Toronto, ON, Canada.; Insitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.; Department of Medicine, University of Toronto, Toronto, ON, Canada., Downar J; Division of Palliative Care, Dept of Medicine, University of Ottawa, Ottawa, ON, Canada.; Bruyere Research Institute, Ottawa, ON, Canada.; Queensland University of Technology School of Law, Queensland, Australia., Isenberg SR; Division of Palliative Care, Dept of Medicine, University of Ottawa, Ottawa, ON, Canada.; Bruyere Research Institute, Ottawa, ON, Canada.; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada., Lapp J; Department of Medicine, Sinai Health System, Toronto, ON, Canada.; Northern Ontario School of Medicine University, Sudbury, ON, Canada., Mokhtarnia M; Department of Medicine, Sinai Health System, Toronto, ON, Canada., Stall N; Department of Medicine, Sinai Health System, Toronto, ON, Canada.; Department of Medicine, University of Toronto, Toronto, ON, Canada.; Women's Age Lab, Women's College Hospital, Toronto, ON, Canada., Tanuseputro P; ICES, Toronto and Ottawa, ON, Canada.; Insitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.; Division of Palliative Care, Dept of Medicine, University of Ottawa, Ottawa, ON, Canada.; Bruyere Research Institute, Ottawa, ON, Canada.; Ottawa Hospital Research Institute, Ottawa, ON, Canada., Quinn KL; Department of Medicine, Sinai Health System, Toronto, ON, Canada.; ICES, Toronto and Ottawa, ON, Canada.; Insitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.; Department of Medicine, University of Toronto, Toronto, ON, Canada.; Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Nov 27; Vol. 19 (11), pp. e0301813. Date of Electronic Publication: 2024 Nov 27 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0301813
Abstrakt: Objective: To measure the association between types of serious illness and the use of different physician-delivered care models near the EOL during the COVID-19 pandemic.
Design, Setting and Participants: Population-based cohort study using health administrative datasets in Ontario, Canada, for adults aged ≥18 years in their last 90 days of life who died of cancer or terminal noncancer illness and received physician-delivered care models near the end-of-life between March 14, 2020 and January 24, 2022.
Exposure: The type of serious illness (cancer or terminal noncancer illness).
Main Outcome: Physician-delivered care models for adults in the last 90 days of life (exclusively virtual, exclusively home-based in-person, or mixed).
Results: The study included 75,930 adults (median age 78 years, 49% female, cancer n = 58,894 [78%], noncancer illness n = 17,036 [22%]). A higher proportion of people with cancer (39.3%) received mixed model of care compared to those with noncancer illnesses (chronic organ failure 24.4%, dementia 37.9%, multimorbidity 28%). Compared to people with cancer, people with chronic organ failure (adjusted odds ratio [aOR], 1.61, 95% CI: 1.54 to 1.68) and those with multimorbidity ([aOR], 1.49, 95% CI: 1.39 to 1.59) had a higher odds of receiving virtual care than a mixed model of care. People with dementia had a higher odds of home-based in-person care than a mixed model of care ([aOR], 1.47, 95% CI 1.27, 1.71) and virtual care ([aOR], 1.40, 95% CI 1.20-1.62) compared to people with cancer.
Conclusion: A person's type of serious illness was associated with different care models near the end-of-life. This study demonstrates persistent disease-specific differences in care delivery or possibly the tailoring of models of care in the last 90 days of life based on a person's specific care needs.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Akhter et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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