Impact of the Timing of Integrated Home Palliative Care Enrolment on Emergency Department Visits

Background  The association between timing of integrated home palliative care (IHPC) enrolment and emergency department (ED) visits is still under debate, and no studies investigated the effect of the timing of IHPC enrolment on ED visits, according to their level of emergency. This study aimed to investigate the impact of the timing of IHPC enrolment on different acuity ED visits.Methods  A retrospective, pre-/post-intervention study was conducted from ۲۰۱۳ to ۲۰۱۹ in Italy. Analyses were stratified by IHPC duration (short ≤۳۰ days; medium ۳۱-۹۰ days; long >۹۰ days) and triage tags (white/green: low level of emergency visit; yellow/red: medium-to-high level). The impact of the timing of IHPC enrolment was evaluated in two ways: incidence rate ratios (IRRs) of ED visits were determined (۱) before and after IHPC enrolment in each group and (۲) post-IHPC among groups.Results  A cohort of ۱۷ ۹۸۳ patients was analysed. Patients enrolled early in the IHPC programme had a significantly lower incidence rate of ED visits than the pre-enrolment period (IRR = ۰.۶۵). The incidence rates of white/green and yellow/red ED visits were significantly lower post-IHPC enrolment for patients enrolled early (IRR = ۰.۶۳ and ۰.۶۷, respectively). All results were statistically significant (P < .۰۰۱). Comparing the IHPC groups after enrolment versus the short group, medium and long IHPC groups had a significant reduction of ED visits (IRR = ۰.۳۷, IRR = ۰.۱۴ respectively), showing a relation between the timing of IHPC enrolment and the incidence of ED visits. A similar trend was observed after accounting for triage tags of ED visits.Conclusion  The timing of IHPC enrolment is related with a variation of the incidence of ED visits. Early IHPC enrolment is related to a high significant reduction of ED visits when compared to the ۹۰-day pre-IHPC enrolment period and to late IHPC enrolment, accounting for both low-level and medium-to-high level emergency ED visits.

Keywords:

Palliative Care , Home Care , Emergency Department Use , Timing of Care