The Impact of Integrated Home Palliative Care Services on Resource Use and Place of Death

Background: Specialized home-based palliative care (HPC) services aim at reducing the number of visits to emergency departments (EDs) and hospitalizations at end of life. In addition, it offers patients the possibility to die at home. Objective: To investigate whether the last years' expansion of palliative care in Stockholm County, Sweden, reduced the health care resource use and/or increased the number of patients who died at home. Design: This is a population-based study of all registered 2780 patients referred to HPC in 2015 in the Stockholm region. The majority of the patients (2087) had cancer, but 693 patients had chronic medical illness, most often cardiovascular and pulmonary diseases. Results: HPC reduced visits to the ED and hospital admissions by 51% and 41%, respectively. The number of hospital admissions to the departments of oncology, medicine, and surgery was reduced, whereas admissions to palliative care units increased. For the 1773 patients alive after 90 days with HPC, the number of days spent in hospital reduced from 19,628 before HPC to 13,743 (30%) days with HPC. The most common place of death was at a specialized palliative care unit (48%), whereas 36% died at home. Conclusions: HPC reduced emergency health care resource use for the majority of patients, despite patients having progressing disease. To improve the quality of end-of-life care, we need to make early integration of palliative care available for a larger number of patients. In addition, we have to improve care pathways, especially for patients with gastrointestinal and lung cancer, who continued to be frequently admitted to hospital.