Associations between physician home visits for the dying and place of death: A population-based retrospective cohort study

Peter Tanuseputro, Sarah Beach, Mathieu Chalifoux, Walter P Wodchis, Amy T Hsu, Hsien Seow, Douglas G Manuel, Peter Tanuseputro, Sarah Beach, Mathieu Chalifoux, Walter P Wodchis, Amy T Hsu, Hsien Seow, Douglas G Manuel

Abstract

Background: While most individuals wish to die at home, the reality is that most will die in hospital.

Aim: To determine whether receiving a physician home visit near the end-of-life is associated with lower odds of death in a hospital.

Design: Observational retrospective cohort study, examining location of death and health care in the last year of life.

Setting/participants: Population-level study of Ontarians, a Canadian province with over 13 million residents. All decedents from April 1, 2010 to March 31, 2013 (n = 264,754).

Results: More than half of 264,754 decedents died in hospital: 45.7% died in an acute care hospital and 7.7% in complex continuing care. After adjustment for multiple factors-including patient illness, home care services, and days of being at home-receiving at least one physician home visit from a non-palliative care physician was associated with a 47% decreased odds (odds-ratio, 0.53; 95%CI: 0.51-0.55) of dying in a hospital. When a palliative care physician specialist was involved, the overall odds declined by 59% (odds ratio, 0.41; 95%CI: 0.39-0.43). The same model, adjusting for physician home visits, showed that receiving palliative home care was associated with a similar reduction (odds ratio, 0.49; 95%CI: 0.47-0.51).

Conclusion: Location of death is strongly associated with end-of-life health care in the home. Less than one-third of the population, however, received end-of-life home care or a physician visit in their last year of life, revealing large room for improvement.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Location of death of 264,754…
Fig 1. Location of death of 264,754 decedents by sex, 2010/11-2012/13.
Fig 2. Effect of physician home visits…
Fig 2. Effect of physician home visits by day of visit prior to death, for decedents who are home (i.e., out-of-hospital) at any given day in the last month prior to death.

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