Association of palliative care with days at home and healthcare use in patients with advanced chronic obstructive pulmonary disease: 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. 2022; 19(1):48-57. Epub 2021 Jun 25. DOI: https://doi.org/10.1513/AnnalsATS.202007-859OC
Rationale — Palliative care focuses on improving quality of life for patients with life-limiting conditions. Although previous studies have shown palliative care to be associated with reduced acute healthcare use in people with cancer and other illnesses, these findings may not generalize to patients with chronic obstructive pulmonary disease (COPD).
Objectives — We examined the association between palliative care and rates of days at home, locations of death, and acute healthcare 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 up until March 2018. Patients who received palliative care were matched 1:1 with those who did not receive palliative care in terms of age, sex, long-term oxygen, previous COPD hospitalizations and propensity scores. Rate ratios (RR) were estimated by 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% confidence interval [CI], 0.97–1.05) but were more likely to die at home (16.4% vs. 10.0%; P < 0.001) compared with those who did not receive palliative care. Rates of healthcare use 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 use but was associated with a modest increase in the proportion who died at home. Future work should evaluate palliative care strategies designed specifically for patients with COPD.