Temporal association between home nursing and hospital costs at end of life in three provinces

  • H. Seow McMaster University
  • R. Pataky Canadian Centre for Applied Research in Cancer Control
  • B. Lawson Dalhousie University
  • E.M. O'Leary McMaster University
  • R. Sutradhar Institute for Clinical Evaluative Sciences; University of Toronto
  • K. Fassbender University of Alberta
  • K. McGrail University of British Columbia
  • L. Barbera Institute for Clinical Evaluative Sciences; University of Toronto
  • F. Burge Dalhousie University
  • S.J. Peacock Canadian Centre for Applied Research in Cancer Control; BC Cancer Agency and University of British Columbia
  • J.S. Hoch Canadian Centre for Applied Research in Cancer Control; Institute for Clinical Evaluative Sciences; University of Toronto; St. Michael’s Hospital
Keywords: Palliative care, homecare, nursing, hospitalization, costing, end of life, Canadian data

Abstract

Background

Research has demonstrated that increases in palliative homecare nursing are associated with a reduction in the rate of subsequent hospitalizations. However, little evidence is available about the cost-savings potential of palliative nursing when accounting for both increased nursing costs and potentially reduced hospital costs.

Methods

Our retrospective cohort study included cancer decedents from British Columbia, Ontario, and Nova Scotia who received any palliative nursing in the last 6 months of life. A Poisson regression analysis was used to determine the association of increased nursing costs (in 2-week blocks) on the relative average hospital costs in the subsequent 2-week block and on the overall total cost (hospital costs plus nursing costs in the preceding 2-week block).

Results

The cohort included 58,022 cancer decedents. Results of the analysis for the last month of life showed an association between increased nursing costs and decreased relative hospital costs in comparisons with a reference group (>0 to 1 hour nursing in the block): the maximum decrease was 55% for Ontario, 31% for British Columbia, and 38% for Nova Scotia. Also, increased nursing costs in the last month were almost always associated with lower total costs in comparison with the reference. For example, cost savings per person-block ranged from $376 (>10 nursing hours) to $1,124 (>4 to 6 nursing hours) in British Columbia.

Conclusions

In the last month of life, increased palliative nursing costs (compared with costs for >0 to 1 hour of nursing in the block) were associated with lower relative hospital costs and a lower total cost in a subsequent block. Our research suggests a cost-savings potential associated with increased community-based palliative nursing.

Author Biographies

H. Seow, McMaster University

Department of Oncology

B. Lawson, Dalhousie University
Department of Family Medicine
E.M. O'Leary, McMaster University
Department of Oncology
R. Sutradhar, Institute for Clinical Evaluative Sciences; University of Toronto
Dalla Lana School of Public Health
K. Fassbender, University of Alberta
Department of Palliative Care Medicine
K. McGrail, University of British Columbia

Centre for Health Services and Policy Research, School of Population and Public Health

L. Barbera, Institute for Clinical Evaluative Sciences; University of Toronto
Department of Radiation Oncology
F. Burge, Dalhousie University
Department of Family Medicine
J.S. Hoch, Canadian Centre for Applied Research in Cancer Control; Institute for Clinical Evaluative Sciences; University of Toronto; St. Michael’s Hospital

Toronto Health Economics and Technology Assessment Collaborative, Faculty of Pharmacy, Institute of Health Policy, Management and Evaluation; Pharmacoeconomics Research Unit, Centre for Excellence in Economic Analysis Research

Published
2016-01-05
How to Cite
Seow, H., Pataky, R., Lawson, B., O’Leary, E., Sutradhar, R., Fassbender, K., McGrail, K., Barbera, L., Burge, F., Peacock, S., & Hoch, J. (2016). Temporal association between home nursing and hospital costs at end of life in three provinces. Current Oncology, 23, S42-S51. https://doi.org/10.3747/co.23.2971
Section
Canadian Cancer Costing Research