Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
BMC Palliat Care. 2018 May 4;17(1):70. doi: 10.1186/s12904-018-0321-5.
Several studies have demonstrated the benefits of early initiation of end-of-life care, particularly homecare nursing services. However, there is little research on variations in the timing of when end-of-life homecare nursing is initiated and no established benchmarks.
This is a retrospective cohort study of patients with a cancer-confirmed cause of death between 2004 and 2009, from three Canadian provinces (British Columbia, Nova Scotia, and Ontario). We linked multiple administrative health databases within each province to examine homecare use in the last 6 months of life. Our primary outcome was mean time (in days) to first end-of-life homecare nursing visit, starting from 6 months before death, by region. We developed an empiric benchmark for this outcome using a funnel plot, controlling for region size.
Of the 28 regions, large variations in the outcome were observed, with the longest mean time (97 days) being two-fold longer than the shortest (55 days). On average, British Columbia and Nova Scotia had the first and second shortest mean times, respectively. The province of Ontario consistently had longer mean times. The empiric benchmark mean based on best-performing regions was 57 mean days.
Significant variation exists for the time to initiation of end-of-life homecare nursing across regions. Understanding regional variation and developing an empiric benchmark for homecare nursing can support health system planners to set achievable targets for earlier initiation of end-of-life care.
多项研究表明，尽早开始临终关怀，特别是家庭护理服务，具有益处。然而，关于临终家庭护理开始时间的变化的研究很少，也没有既定的基准。
这是一项回顾性队列研究，研究对象为 2004 年至 2009 年间死于癌症的来自加拿大三个省（不列颠哥伦比亚省、新斯科舍省和安大略省）的患者。我们在每个省内将多个行政健康数据库进行了链接，以检查生命最后 6 个月内的家庭护理使用情况。我们的主要结果是，根据区域，从死亡前 6 个月开始，首次临终家庭护理访问的平均时间（以天为单位）。我们使用漏斗图对此结果进行了实证基准测试，控制了区域大小。
在 28 个区域中，观察到该结果存在很大差异，最长的平均时间（97 天）是最短的两倍（55 天）。平均而言，不列颠哥伦比亚省和新斯科舍省分别具有第一和第二短的平均时间。安大略省的平均时间一直较长。基于表现最佳的区域的经验基准平均时间为 57 个平均天。
临终家庭护理开始时间在区域之间存在显著差异。了解区域差异并为家庭护理制定经验基准可以支持卫生系统规划者为更早开始临终关怀设定可实现的目标。
