Physician and nurse practitioner home visits at end of life associated with better patient outcomes: a population-based study

#Context

Home visits at the end of life decrease hospitalizations and hospital deaths, which reduces healthcare costs and aligns with most patients’ wishes. In addition to family physicians, nurse practitioners (NPs) play a critical role in meeting the rising demand for home and community-based palliative care. However, very few population-level studies have examined practice patterns of NPs delivering home-based end-of-life care and the collaboration between physicians and NPs.

#Objective

To describe the characteristics and outcomes of patients receiving home-based palliative care provided by physicians and NPs in the last 90 days of life

#Study Design and Analysis

Retrospective population-based study with a descriptive analysis of patient characteristics and multivariate logistic regression analyses of end-of-life outcomes controlling for patients’ demographics, health, and healthcare use.

#Setting or Dataset

Healthcare administrative data in Ontario, Canada.

#Populations Studied

Adults 19 years and older who died between January 1, 2018, and December 31, 2019, and received home care in their last 90 days of life (N=103,664).

#Intervention/Instrument

Receipt of home visits by an NP, physician, or both.

#Outcome Measures

Receipt of medications for symptoms (e.g., pain, delirium/agitation, and terminal secretion) in the last 3 weeks of life, acute care use in the last 3 weeks of life, and location of death.

#Results

There were 221,047 eligible clients. Social determinants and clinical conditions are most prominent in CHCs serving those most at risk in urban settings; the former are also more prevalent in clients with multimorbidity. Physician and nursing types provide most care, with heterogeneous combinations of other providers. There is notable within- and between-client variability in care complexity and frequency. We identify implications for future analyses such as cohort building and risk prediction.

#Conclusions

The receipt of at least 1 NP or physician home visit at the end of life can significantly reduce acute care use, improve access to symptom management medications, and mitigate hospital-based deaths. Collaboration between NPs and physicians was associated with greater benefits to patients’ outcomes.

#Upon completion of this session, participants should be able to

1. Understand the importance of collaborative primary care home visits on a patient’s dying experience.
2. Describe the advantage and limitations of using healthcare administrative data to study practice patterns of NPs and MDs delivering home-based end-of-life care.