Association between palliative care, days at home, and health care use in patients with advanced COPD: a cohort study
Maclagan LC, Wu F, Liu N, Tanuseputro P, Stukel TA, Guan J, Kendzerska T, Stefan MS, Lindenauer PK, Gershon AS. Ann Am Thorac Soc. 2021; Jun 25 [Epub ahead of print]. DOI: https://doi.org/10.1513/AnnalsATS.202007-859OC
Rationale — Palliative care focuses on improving quality of life for patients with life-limiting conditions. While previous studies have shown palliative care to be associated with reduced acute health care use in people with cancer and other illnesses, these findings may not generalize to patients with COPD.
Objectives — We examined the association between palliative care and rates of days at home, location of death, and acute health care use in patients with COPD.
Methods — We used health administrative databases in Ontario, Canada to identify patients with advanced COPD hospitalized between April 2010 and March 2017 and followed until March 2018. Patients who received palliative care were matched 1:1 to those who did not on age, sex, long-term oxygen, previous COPD hospitalizations and propensity scores. Rate ratios (RR) were estimated using Poisson models with generalized estimating equations to account for matching.
Results — Among 35,492 patients, 1,788 (5%) received palliative care. In the matched cohort (1,721 pairs), people with COPD receiving palliative care had similar rates of days at home (RR=1.01, 95% CI [0.97, 1.05]) but were more likely to die at home (16.4% vs. 10.0%, p<0.001) compared to those who did not receive palliative care. Rates of healthcare utilization were similar except for increased hospitalizations in the palliative care group (RR=1.09, 95% CI [1.01, 1.18]).
Conclusions — Receipt of palliative care did not reduce days at home or healthcare utilization but was associated with a modest increase in proportion dying at home. Future work should evaluate palliative care strategies designed specifically for patients with COPD.