Journal article information
- Journal of publication: BMJ Supportive & Palliative Care
- Nuffield Trust contributors: Dr Adam Steventon, Dr Martin Bardsley, Theo Georghiou and Xavier Chitnis
Retrospective analysis using matched controls and administrative data.
Community-based care in England.
29 538 people aged over 18 who received Marie Curie nursing support compared with 29 538 controls individually matched on variables including: age, socioeconomic deprivation, prior hospital use, number of chronic conditions and prior diagnostic history.
Home-based end-of-life nursing care delivered by the Marie Curie Nursing Service (MCNS), compared with end-of-life care available to those who did not receive MCNS care.
Main outcome measures
Proportion of people who died at home; numbers of emergency and elective inpatient admissions, outpatient attendances and attendances at emergency departments in the period until death; and notional costs of hospital care.
Intervention patients were significantly more likely to die at home and less likely to die in hospital than matched controls (unadjusted OR 6.16, 95% CI 5.94 to 6.38, p<0.001). Hospital activity was significantly lower among intervention than matched control patients (emergency admissions: 0.14 vs 0.44 admissions per person, p<0.001) and average costs across all hospital services were lower (unadjusted average costs per person, £610 (intervention patients) vs £1750 (matched controls), p<0.001). Greater activity and cost differences were seen in those patients who had been receiving home nursing for longer.
Home-based end-of-life care offers the potential to reduce demand for acute hospital care and increase the number of people able to die at home.