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Impact of home-based palliative care on health care costs and hospital use: A systematic review

Published online by Cambridge University Press:  09 December 2020

Valentina Gonzalez-Jaramillo
Affiliation:
Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland Graduate School for Health Sciences, University of Bern, Bern, Switzerland
Valérie Fuhrer
Affiliation:
University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
Nathalia Gonzalez-Jaramillo
Affiliation:
Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland Graduate School for Health Sciences, University of Bern, Bern, Switzerland
Doris Kopp-Heim
Affiliation:
Public Health & Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
Steffen Eychmüller
Affiliation:
University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
Maud Maessen
Affiliation:
Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
Corresponding

Abstract

Objective

To assess the effectiveness of home-based palliative care (HBPC) on reducing hospital visits and whether HBPC lowered health care cost.

Method

We searched six bibliographic databases (Embase (Ovid); Cochrane Central Register of Controlled Trials; Medline (Ovid); PubMed; Web of Science Core Collection; and, CINAHL) until February 2019 and performed a narrative synthesis of our findings.

Results

Of the 1,426 identified references, 21 articles based on 19 unique studies met our inclusion criteria, which involved 92,000 participants. In both oncological and non-oncological patients, HBPC consistently reduced the number of hospital visits and their length, as well as hospitalization costs and overall health care costs. Even though home-treated patients consumed more outpatient resources, a higher saving in the hospital costs counterbalanced this. The reduction in overall health care costs was most noticeable for study periods closer to death, with greater reductions in the last 2 months, last month, and last two weeks of life.

Significance of results

Stakeholders should recognize HBPC as an intervention that decreases patient care costs at end of life and therefore health care providers should assess the preferences of patients nearing the end-of-life to identify those who will benefit most from HBPC.

Type
Review Article
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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