Utilization and quality of primary and specialized palliative homecare in nursing home residents vs. community dwellers: a claims data analysis
Abstract Background There are hardly any data on the extent to which nursing home residents are provided with palliative homecare. We want to add evidence by comparing nursing home residents (who had been living in a nursing home for at least one year) and nursing-care-dependent community dwellers i...
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BMC
2025-01-01
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| Series: | BMC Palliative Care |
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| Online Access: | https://doi.org/10.1186/s12904-024-01631-z |
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| author | Juliane Poeck Franziska Meissner Bianka Ditscheid Markus Krause Ulrich Wedding Cordula Gebel Ursula Marschall Gabriele Meyer Werner Schneider Antje Freytag |
| author_facet | Juliane Poeck Franziska Meissner Bianka Ditscheid Markus Krause Ulrich Wedding Cordula Gebel Ursula Marschall Gabriele Meyer Werner Schneider Antje Freytag |
| author_sort | Juliane Poeck |
| collection | DOAJ |
| description | Abstract Background There are hardly any data on the extent to which nursing home residents are provided with palliative homecare. We want to add evidence by comparing nursing home residents (who had been living in a nursing home for at least one year) and nursing-care-dependent community dwellers in terms of utilization and quality of palliative homecare. Methods We conducted a population-based study with nationwide claims data from deceased beneficiaries of a large German health insurance provider. First, we compared utilization rates of primary palliative care [PPC], specialized palliative homecare [SPHC], and no palliative care [noPC] between nursing home residents and community dwellers, both descriptively and adjusted for covariates. Second, we analyzed the (adjusted) relationship between PPC-only and SPHC (both: starting ≥ 30 days before death), and noPC with healthcare indicators (death in hospital, hospitalization, emergencies, intensive care treatment within the last 30 days of life), and compared these relationships between nursing home residents and community dwellers. Analyses were conducted using simple and multiple logistic regression. Data were standardized by age and gender. Results From 117,436 decedents in 2019, 71,803 could be included in the first, 55,367 in the second analysis. The rate of decedents with noPC was higher in nursing home residents (61.3%) compared to community dwellers (56.6%). Nursing home residents received less SPHC (10.7% vs. 23.2%) but more PPC (30.3% vs. 27.0%) than community dwellers, and achieved better outcomes across all end-of-life healthcare indicators. Adjusted for covariates, both types of palliative homecare were associated with beneficial outcomes, in nursing home residents as well as in community dwellers, with generally better outcomes for SPHC than PPC-only. For most outcomes, the associations with palliative homecare were equal or smaller in nursing home residents than in community dwellers. Conclusions The overall better performance in quality of end-of-life care in nursing home residents than in community dwellers may be due to the institutionally provided nursing and general practitioner care within nursing homes. This may also explain higher rates of PPC and lower rates of SPHC in nursing home residents, and why the relationship with both PPC and SPHC are smaller in nursing home residents. Trial registration German Clinical Trials Register (DRKS): [DRKS00024133, Date of registration: 28.06.2021]. |
| format | Article |
| id | doaj-art-5a1a8b1705cf4f308ce56f520ce76fea |
| institution | Kabale University |
| issn | 1472-684X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj-art-5a1a8b1705cf4f308ce56f520ce76fea2025-01-26T12:57:46ZengBMCBMC Palliative Care1472-684X2025-01-0124111310.1186/s12904-024-01631-zUtilization and quality of primary and specialized palliative homecare in nursing home residents vs. community dwellers: a claims data analysisJuliane Poeck0Franziska Meissner1Bianka Ditscheid2Markus Krause3Ulrich Wedding4Cordula Gebel5Ursula Marschall6Gabriele Meyer7Werner Schneider8Antje Freytag9Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller University JenaInstitute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller University JenaInstitute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller University JenaInstitute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller University JenaDepartment of Palliative Care, Jena University Hospital, Friedrich-Schiller University JenaDepartment of Palliative Care, Jena University Hospital, Friedrich-Schiller University JenaBARMERInstitute of Health and Nursing Sciences, Martin Luther University Halle-WittenbergCenter for Interdisciplinary Health Research, University of AugsburgInstitute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller University JenaAbstract Background There are hardly any data on the extent to which nursing home residents are provided with palliative homecare. We want to add evidence by comparing nursing home residents (who had been living in a nursing home for at least one year) and nursing-care-dependent community dwellers in terms of utilization and quality of palliative homecare. Methods We conducted a population-based study with nationwide claims data from deceased beneficiaries of a large German health insurance provider. First, we compared utilization rates of primary palliative care [PPC], specialized palliative homecare [SPHC], and no palliative care [noPC] between nursing home residents and community dwellers, both descriptively and adjusted for covariates. Second, we analyzed the (adjusted) relationship between PPC-only and SPHC (both: starting ≥ 30 days before death), and noPC with healthcare indicators (death in hospital, hospitalization, emergencies, intensive care treatment within the last 30 days of life), and compared these relationships between nursing home residents and community dwellers. Analyses were conducted using simple and multiple logistic regression. Data were standardized by age and gender. Results From 117,436 decedents in 2019, 71,803 could be included in the first, 55,367 in the second analysis. The rate of decedents with noPC was higher in nursing home residents (61.3%) compared to community dwellers (56.6%). Nursing home residents received less SPHC (10.7% vs. 23.2%) but more PPC (30.3% vs. 27.0%) than community dwellers, and achieved better outcomes across all end-of-life healthcare indicators. Adjusted for covariates, both types of palliative homecare were associated with beneficial outcomes, in nursing home residents as well as in community dwellers, with generally better outcomes for SPHC than PPC-only. For most outcomes, the associations with palliative homecare were equal or smaller in nursing home residents than in community dwellers. Conclusions The overall better performance in quality of end-of-life care in nursing home residents than in community dwellers may be due to the institutionally provided nursing and general practitioner care within nursing homes. This may also explain higher rates of PPC and lower rates of SPHC in nursing home residents, and why the relationship with both PPC and SPHC are smaller in nursing home residents. Trial registration German Clinical Trials Register (DRKS): [DRKS00024133, Date of registration: 28.06.2021].https://doi.org/10.1186/s12904-024-01631-zPalliative carePrimary palliative careSpecialized palliative homecareNursing homeEnd of lifeQuality of healthcare |
| spellingShingle | Juliane Poeck Franziska Meissner Bianka Ditscheid Markus Krause Ulrich Wedding Cordula Gebel Ursula Marschall Gabriele Meyer Werner Schneider Antje Freytag Utilization and quality of primary and specialized palliative homecare in nursing home residents vs. community dwellers: a claims data analysis BMC Palliative Care Palliative care Primary palliative care Specialized palliative homecare Nursing home End of life Quality of healthcare |
| title | Utilization and quality of primary and specialized palliative homecare in nursing home residents vs. community dwellers: a claims data analysis |
| title_full | Utilization and quality of primary and specialized palliative homecare in nursing home residents vs. community dwellers: a claims data analysis |
| title_fullStr | Utilization and quality of primary and specialized palliative homecare in nursing home residents vs. community dwellers: a claims data analysis |
| title_full_unstemmed | Utilization and quality of primary and specialized palliative homecare in nursing home residents vs. community dwellers: a claims data analysis |
| title_short | Utilization and quality of primary and specialized palliative homecare in nursing home residents vs. community dwellers: a claims data analysis |
| title_sort | utilization and quality of primary and specialized palliative homecare in nursing home residents vs community dwellers a claims data analysis |
| topic | Palliative care Primary palliative care Specialized palliative homecare Nursing home End of life Quality of healthcare |
| url | https://doi.org/10.1186/s12904-024-01631-z |
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