Regional collaborative home-based palliative care and health care outcomes among adults with heart failure.

Adult Chronic Disease Cohort Studies Delivery of Health Care Heart Failure / therapy Home Care Services Humans Ontario Palliative Care Terminal Care

Journal

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
ISSN: 1488-2329
Titre abrégé: CMAJ
Pays: Canada
ID NLM: 9711805

Informations de publication

Date de publication:
26 09 2022
Historique:
accepted: 29 08 2022
entrez: 26 9 2022
pubmed: 27 9 2022
medline: 28 9 2022
Statut: ppublish

Résumé

Innovative models of collaborative palliative care are urgently needed to meet gaps in end-of-life care among people with heart failure. We sought to determine whether regionally organized, collaborative, home-based palliative care that involves cardiologists, primary care providers and palliative care specialists, and that uses shared decision-making to promote goal- and need-concordant care for patients with heart failure, was associated with a greater likelihood of patients dying at home than in hospital. We conducted a population-based matched cohort study of adults who died with chronic heart failure across 2 large health regions in Ontario, Canada, between 2013 and 2019. The primary outcome was location of death. Secondary outcomes included rates of health care use, including unplanned visits to the emergency department, hospital admissions, hospital lengths of stay, admissions to the intensive care unit, number of visits with primary care physicians or cardiologists, number of home visits by palliative care physicians or nurse practitioners, and number of days spent at home. Patients who received regionally organized, collaborative, home-based palliative care ( Adoption of a model of regionally organized, collaborative, home-based palliative care that uses shared decision-making may improve end-of-life outcomes for people with chronic heart failure.

Sections du résumé

BACKGROUND
Innovative models of collaborative palliative care are urgently needed to meet gaps in end-of-life care among people with heart failure. We sought to determine whether regionally organized, collaborative, home-based palliative care that involves cardiologists, primary care providers and palliative care specialists, and that uses shared decision-making to promote goal- and need-concordant care for patients with heart failure, was associated with a greater likelihood of patients dying at home than in hospital.
METHODS
We conducted a population-based matched cohort study of adults who died with chronic heart failure across 2 large health regions in Ontario, Canada, between 2013 and 2019. The primary outcome was location of death. Secondary outcomes included rates of health care use, including unplanned visits to the emergency department, hospital admissions, hospital lengths of stay, admissions to the intensive care unit, number of visits with primary care physicians or cardiologists, number of home visits by palliative care physicians or nurse practitioners, and number of days spent at home.
RESULTS
Patients who received regionally organized, collaborative, home-based palliative care (
INTERPRETATION
Adoption of a model of regionally organized, collaborative, home-based palliative care that uses shared decision-making may improve end-of-life outcomes for people with chronic heart failure.

Identifiants

DOI: 10.1503/cmaj.220784 PMID: 36162834 PMC: PMC9512159
pubmed: 36162834
pii: 194/37/E1274
doi: 10.1503/cmaj.220784
pmc: PMC9512159
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

E1274-E1282

Commentaires et corrections

Type : CommentIn

Informations de copyright

© 2022 CMA Impact Inc. or its licensors.

Déclaration de conflit d'intérêts

Competing interests: Leah Steinberg reports participating on the cardiac leadership committee with CorHealth. No other competing interests were declared.

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Auteurs

Kieran L Quinn (KL)

Department of Medicine (Quinn, Campos, Graham, Mak), University of Toronto, Toronto, Ont.; ICES (Quinn, Stukel, Tanuseputro, Tuna), Toronto, Ont. and Ottawa, Ont.; Department of Medicine (Quinn, Mak, Steinberg), Sinai Health System; Interdepartmental Division of Palliative Care (Quinn, Steinberg), Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ont.; Division of Palliative Medicine, Department of Family and Preventive Medicine (Kavalieratos), Emory University, Atlanta, Ga.; Clinical Epidemiology Program (Tanuseputro, Tuna), Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine (Tanuseputro) and Department of Medicine (Tanuseputro, Isenberg), University of Ottawa; Bruyère Research Institute (Tanuseputro, Isenberg), Ottawa, Ont.; Department of Family and Community Medicine (Quinn, Steinberg, Isenberg), University of Toronto; Division of Cardiology (Mak), Sinai Health System; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont.

Therese A Stukel (TA)

Department of Medicine (Quinn, Campos, Graham, Mak), University of Toronto, Toronto, Ont.; ICES (Quinn, Stukel, Tanuseputro, Tuna), Toronto, Ont. and Ottawa, Ont.; Department of Medicine (Quinn, Mak, Steinberg), Sinai Health System; Interdepartmental Division of Palliative Care (Quinn, Steinberg), Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ont.; Division of Palliative Medicine, Department of Family and Preventive Medicine (Kavalieratos), Emory University, Atlanta, Ga.; Clinical Epidemiology Program (Tanuseputro, Tuna), Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine (Tanuseputro) and Department of Medicine (Tanuseputro, Isenberg), University of Ottawa; Bruyère Research Institute (Tanuseputro, Isenberg), Ottawa, Ont.; Department of Family and Community Medicine (Quinn, Steinberg, Isenberg), University of Toronto; Division of Cardiology (Mak), Sinai Health System; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont.

Erin Campos (E)

Department of Medicine (Quinn, Campos, Graham, Mak), University of Toronto, Toronto, Ont.; ICES (Quinn, Stukel, Tanuseputro, Tuna), Toronto, Ont. and Ottawa, Ont.; Department of Medicine (Quinn, Mak, Steinberg), Sinai Health System; Interdepartmental Division of Palliative Care (Quinn, Steinberg), Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ont.; Division of Palliative Medicine, Department of Family and Preventive Medicine (Kavalieratos), Emory University, Atlanta, Ga.; Clinical Epidemiology Program (Tanuseputro, Tuna), Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine (Tanuseputro) and Department of Medicine (Tanuseputro, Isenberg), University of Ottawa; Bruyère Research Institute (Tanuseputro, Isenberg), Ottawa, Ont.; Department of Family and Community Medicine (Quinn, Steinberg, Isenberg), University of Toronto; Division of Cardiology (Mak), Sinai Health System; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont.

Cassandra Graham (C)

Department of Medicine (Quinn, Campos, Graham, Mak), University of Toronto, Toronto, Ont.; ICES (Quinn, Stukel, Tanuseputro, Tuna), Toronto, Ont. and Ottawa, Ont.; Department of Medicine (Quinn, Mak, Steinberg), Sinai Health System; Interdepartmental Division of Palliative Care (Quinn, Steinberg), Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ont.; Division of Palliative Medicine, Department of Family and Preventive Medicine (Kavalieratos), Emory University, Atlanta, Ga.; Clinical Epidemiology Program (Tanuseputro, Tuna), Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine (Tanuseputro) and Department of Medicine (Tanuseputro, Isenberg), University of Ottawa; Bruyère Research Institute (Tanuseputro, Isenberg), Ottawa, Ont.; Department of Family and Community Medicine (Quinn, Steinberg, Isenberg), University of Toronto; Division of Cardiology (Mak), Sinai Health System; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont.

Dio Kavalieratos (D)

Department of Medicine (Quinn, Campos, Graham, Mak), University of Toronto, Toronto, Ont.; ICES (Quinn, Stukel, Tanuseputro, Tuna), Toronto, Ont. and Ottawa, Ont.; Department of Medicine (Quinn, Mak, Steinberg), Sinai Health System; Interdepartmental Division of Palliative Care (Quinn, Steinberg), Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ont.; Division of Palliative Medicine, Department of Family and Preventive Medicine (Kavalieratos), Emory University, Atlanta, Ga.; Clinical Epidemiology Program (Tanuseputro, Tuna), Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine (Tanuseputro) and Department of Medicine (Tanuseputro, Isenberg), University of Ottawa; Bruyère Research Institute (Tanuseputro, Isenberg), Ottawa, Ont.; Department of Family and Community Medicine (Quinn, Steinberg, Isenberg), University of Toronto; Division of Cardiology (Mak), Sinai Health System; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont.

Susanna Mak (S)

Department of Medicine (Quinn, Campos, Graham, Mak), University of Toronto, Toronto, Ont.; ICES (Quinn, Stukel, Tanuseputro, Tuna), Toronto, Ont. and Ottawa, Ont.; Department of Medicine (Quinn, Mak, Steinberg), Sinai Health System; Interdepartmental Division of Palliative Care (Quinn, Steinberg), Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ont.; Division of Palliative Medicine, Department of Family and Preventive Medicine (Kavalieratos), Emory University, Atlanta, Ga.; Clinical Epidemiology Program (Tanuseputro, Tuna), Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine (Tanuseputro) and Department of Medicine (Tanuseputro, Isenberg), University of Ottawa; Bruyère Research Institute (Tanuseputro, Isenberg), Ottawa, Ont.; Department of Family and Community Medicine (Quinn, Steinberg, Isenberg), University of Toronto; Division of Cardiology (Mak), Sinai Health System; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont.

Leah Steinberg (L)

Department of Medicine (Quinn, Campos, Graham, Mak), University of Toronto, Toronto, Ont.; ICES (Quinn, Stukel, Tanuseputro, Tuna), Toronto, Ont. and Ottawa, Ont.; Department of Medicine (Quinn, Mak, Steinberg), Sinai Health System; Interdepartmental Division of Palliative Care (Quinn, Steinberg), Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ont.; Division of Palliative Medicine, Department of Family and Preventive Medicine (Kavalieratos), Emory University, Atlanta, Ga.; Clinical Epidemiology Program (Tanuseputro, Tuna), Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine (Tanuseputro) and Department of Medicine (Tanuseputro, Isenberg), University of Ottawa; Bruyère Research Institute (Tanuseputro, Isenberg), Ottawa, Ont.; Department of Family and Community Medicine (Quinn, Steinberg, Isenberg), University of Toronto; Division of Cardiology (Mak), Sinai Health System; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont.

Peter Tanuseputro (P)

Department of Medicine (Quinn, Campos, Graham, Mak), University of Toronto, Toronto, Ont.; ICES (Quinn, Stukel, Tanuseputro, Tuna), Toronto, Ont. and Ottawa, Ont.; Department of Medicine (Quinn, Mak, Steinberg), Sinai Health System; Interdepartmental Division of Palliative Care (Quinn, Steinberg), Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ont.; Division of Palliative Medicine, Department of Family and Preventive Medicine (Kavalieratos), Emory University, Atlanta, Ga.; Clinical Epidemiology Program (Tanuseputro, Tuna), Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine (Tanuseputro) and Department of Medicine (Tanuseputro, Isenberg), University of Ottawa; Bruyère Research Institute (Tanuseputro, Isenberg), Ottawa, Ont.; Department of Family and Community Medicine (Quinn, Steinberg, Isenberg), University of Toronto; Division of Cardiology (Mak), Sinai Health System; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont.

Meltem Tuna (M)

Department of Medicine (Quinn, Campos, Graham, Mak), University of Toronto, Toronto, Ont.; ICES (Quinn, Stukel, Tanuseputro, Tuna), Toronto, Ont. and Ottawa, Ont.; Department of Medicine (Quinn, Mak, Steinberg), Sinai Health System; Interdepartmental Division of Palliative Care (Quinn, Steinberg), Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ont.; Division of Palliative Medicine, Department of Family and Preventive Medicine (Kavalieratos), Emory University, Atlanta, Ga.; Clinical Epidemiology Program (Tanuseputro, Tuna), Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine (Tanuseputro) and Department of Medicine (Tanuseputro, Isenberg), University of Ottawa; Bruyère Research Institute (Tanuseputro, Isenberg), Ottawa, Ont.; Department of Family and Community Medicine (Quinn, Steinberg, Isenberg), University of Toronto; Division of Cardiology (Mak), Sinai Health System; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont.

Sarina R Isenberg (SR)

Department of Medicine (Quinn, Campos, Graham, Mak), University of Toronto, Toronto, Ont.; ICES (Quinn, Stukel, Tanuseputro, Tuna), Toronto, Ont. and Ottawa, Ont.; Department of Medicine (Quinn, Mak, Steinberg), Sinai Health System; Interdepartmental Division of Palliative Care (Quinn, Steinberg), Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ont.; Division of Palliative Medicine, Department of Family and Preventive Medicine (Kavalieratos), Emory University, Atlanta, Ga.; Clinical Epidemiology Program (Tanuseputro, Tuna), Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine (Tanuseputro) and Department of Medicine (Tanuseputro, Isenberg), University of Ottawa; Bruyère Research Institute (Tanuseputro, Isenberg), Ottawa, Ont.; Department of Family and Community Medicine (Quinn, Steinberg, Isenberg), University of Toronto; Division of Cardiology (Mak), Sinai Health System; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont. sisenberg@bruyere.org.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Regional collaborative home-based palliative...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie chronique › Regional collaborative home-based palliative...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Regional collaborative home-based palliative...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Regional collaborative home-based palliative...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Défaillance cardiaque › Regional collaborative home-based palliative...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services de soins infirmiers › Services de soins à domicile › Regional collaborative home-based palliative...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Regional collaborative home-based palliative...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › Canada › Ontario › Regional collaborative home-based palliative...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins palliatifs › Regional collaborative home-based palliative...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins terminaux › Regional collaborative home-based palliative...