El;ffect of a home-based end-of-life nursing service on hospital use at the end of life and place of death: a study using administrative data and matched controls

Objective To assess the effect of routinely delivered home-based end-of-life care on hospital use at the end of life and place of death. Design Retrospective analysis using matched controls and administrative data. Setting Community-based care in England. Participants 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. Intervention 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. Results 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 pound (intervention patients) vs 1750 pound (matched controls), p<0.001). Greater activity and cost differences were seen in those patients who had been receiving home nursing for longer. Conclusions 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.