{"id":4585,"date":"2018-07-24T00:00:00","date_gmt":"2018-07-24T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/home-palliative-service-utilization-and-care-trajectory-among-ontario-residents-dying-on-chronic-dialysis\/"},"modified":"2023-06-14T20:09:32","modified_gmt":"2023-06-15T00:09:32","slug":"home-palliative-service-utilization-and-care-trajectory-among-ontario-residents-dying-on-chronic-dialysis","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/home-palliative-service-utilization-and-care-trajectory-among-ontario-residents-dying-on-chronic-dialysis\/","title":{"rendered":"Home palliative service utilization and care trajectory among Ontario residents dying on chronic dialysis"},"content":{"rendered":"<p><strong>Background<\/strong> &#x2014;&#xa0; Many patients who receive chronic hemodialysis have a limited life expectancy comparable to that of patients with metastatic cancer. However, patterns of home palliative care use among patients receiving hemodialysis are unknown.<\/p>\n<p><strong>Objectives <\/strong>&#x2014; We aimed to undertake a current-state analysis to inform measurement and quality improvement in palliative service use in Ontario.<\/p>\n<p><strong>Methods<\/strong> &#x2014; We conducted a descriptive study of outcomes and home palliative care use by Ontario residents maintained on chronic dialysis using multiple provincial healthcare datasets. The period of study was the final year of life, for those died between January 2010 and December 2014.<\/p>\n<p><strong>Results <\/strong>&#x2014; We identified 9611 patients meeting inclusion criteria. At death, patients were (median [Q1, Q3] or %): 75 (66, 82) years old, on dialysis for 3.0 (1.0-6.0) years, 41% were women, 65% had diabetes, 29.6% had dementia, and 13.9% had high-impact neoplasms, and 19.9% had discontinued dialysis within 30 days of death. During the last year of life, 13.1% received &#x2a7e;1 home palliative services. Compared with patients who had no palliative services, those who received home palliative care visits had fewer emergency department and intensive care unit visits in the last 30 days of life, more deaths at home (17.1 vs 1.4%), and a lower frequency of deaths with an associated intensive care unit stay (8.1 vs 37.8%).<\/p>\n<p><strong>Conclusions<\/strong> &#x2014; Only a small proportion of patients receiving dialysis in Ontario received support through the home palliative care system. There appears to be an opportunity to improve palliative care support in parallel with dialysis care, which may improve patient, family, and health-system outcomes.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background &#x2014;&#xa0; Many patients who receive chronic hemodialysis have a limited life expectancy comparable to that of patients with metastatic cancer. However, patterns of home palliative care use among patients receiving hemodialysis are unknown. Objectives &#x2014; We aimed to undertake a current-state analysis to inform measurement and quality improvement in palliative service use in Ontario. [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-4585","journal_article","type-journal_article","status-publish","hentry"],"acf":{"citation":"Nesrallah GE, Dixon SN, MacKinnon M, Jassal SV, Bota SE, Dirk JS, Arthurs E, Blake PG, Sood MM, Garg AX, Davison SN. <em>Can J Kidney Health Dis<\/em>. 2018; 5:2054358118783761. Epub 2018 Jul 24.","source_url":"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6073817\/","ices_scientist":[1242,1208],"site":[6739],"research_program":[6743],"news_release":[],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"16BB0FC4-7678-417B-89E2-E8D5B73D5271","sitecore_item_name":"Home-palliative-service-utilization-and-care-trajectory-among-Ontario-residents","sitecore_field_values":"{\n  \"Title\": \"Home palliative service utilization and care trajectory among Ontario residents dying on chronic dialysis\",\n  \"Short title\": \"Home palliative service utilization\",\n  \"Summary\": \"This study provides a current-state analysis to inform measurement and quality improvement in palliative service use in Ontario.\",\n  \"Citation\": \"<p>Nesrallah GE, Dixon SN, MacKinnon M, Jassal SV, Bota SE, Dirk JS, Arthurs E, Blake PG, Sood MM, Garg AX, Davison SN. <em>Can J Kidney Health Dis<\/em>. 2018; 5:2054358118783761. Epub 2018 Jul 24. DOI: <a href=\"http:\/\/doi.org\/10.1177\/2054358118783761\" title=\"opens external link\">10.1177\/2054358118783761<\/a>.<\/p>\",\n  \"Abstract\": \"<p><strong>Background<\/strong> &mdash;&nbsp; Many patients who receive chronic hemodialysis have a limited life expectancy comparable to that of patients with metastatic cancer. However, patterns of home palliative care use among patients receiving hemodialysis are unknown.<\/p>n<p><strong>Objectives <\/strong>&mdash; We aimed to undertake a current-state analysis to inform measurement and quality improvement in palliative service use in Ontario.<\/p>n<p><strong>Methods<\/strong> &mdash; We conducted a descriptive study of outcomes and home palliative care use by Ontario residents maintained on chronic dialysis using multiple provincial healthcare datasets. The period of study was the final year of life, for those died between January 2010 and December 2014.<\/p>n<p><strong>Results <\/strong>&mdash; We identified 9611 patients meeting inclusion criteria. At death, patients were (median [Q1, Q3] or %): 75 (66, 82) years old, on dialysis for 3.0 (1.0-6.0) years, 41% were women, 65% had diabetes, 29.6% had dementia, and 13.9% had high-impact neoplasms, and 19.9% had discontinued dialysis within 30 days of death. During the last year of life, 13.1% received \u2a7e1 home palliative services. Compared with patients who had no palliative services, those who received home palliative care visits had fewer emergency department and intensive care unit visits in the last 30 days of life, more deaths at home (17.1 vs 1.4%), and a lower frequency of deaths with an associated intensive care unit stay (8.1 vs 37.8%).<\/p>n<p><strong>Conclusions<\/strong> &mdash; Only a small proportion of patients receiving dialysis in Ontario received support through the home palliative care system. There appears to be an opportunity to improve palliative care support in parallel with dialysis care, which may improve patient, family, and health-system outcomes.<\/p>n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6073817\/\" title=\"Opens to full text in HTML\">View full text<\/a><\/p>\",\n  \"Research Programs\": \"{92CC48EB-79AA-49F6-8A80-16D185170261}\",\n  \"ICES Locations\": \"{3B4AF7E8-6835-410B-AEB8-360A79CA0ED8}\",\n  \"ICES Scientists\": \"{95F0CC45-E886-4729-A10C-DC4813D54710}|{7091E417-B1CA-4B4D-9626-E4A32E614F5E}|{5B35E46C-9FBF-426F-A11D-1F64B8E9658E}\",\n  \"Posted Date\": \"20180724T000000\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2018\/July\/Home-palliative-service-utilization-and-care-trajectory-among-Ontario-residents"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Home palliative service utilization and care trajectory among Ontario residents dying on chronic dialysis<\/title>\n<meta name=\"description\" content=\"Background &#x2014;&#xa0; Many patients who receive chronic hemodialysis have a limited life expectancy comparable to that of patients with metastatic\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/home-palliative-service-utilization-and-care-trajectory-among-ontario-residents-dying-on-chronic-dialysis\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICES | Home palliative service utilization and care trajectory among Ontario residents dying on chronic dialysis\" \/>\n<meta property=\"og:description\" content=\"Background &#x2014;&#xa0; Many patients who receive chronic hemodialysis have a limited life expectancy comparable to that of patients with metastatic\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/home-palliative-service-utilization-and-care-trajectory-among-ontario-residents-dying-on-chronic-dialysis\/\" \/>\n<meta property=\"og:site_name\" content=\"ICES\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/ICESOntario\/\" \/>\n<meta property=\"article:modified_time\" content=\"2023-06-15T00:09:32+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2024\/11\/ic-es-data-discovery-better-health-logo.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"675\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/home-palliative-service-utilization-and-care-trajectory-among-ontario-residents-dying-on-chronic-dialysis\\\/\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/home-palliative-service-utilization-and-care-trajectory-among-ontario-residents-dying-on-chronic-dialysis\\\/\",\"name\":\"ICES | Home palliative service utilization and care trajectory among Ontario residents dying on chronic dialysis\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#website\"},\"datePublished\":\"2018-07-24T04:00:00+00:00\",\"dateModified\":\"2023-06-15T00:09:32+00:00\",\"description\":\"Background &#x2014;&#xa0; 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