Evidence map›Paper›PMID 24906901›Full record

ArticleBMJ (Clinical research ed.)2014

Impact of community based, specialist palliative care teams on hospitalisations and emergency department visits late in life and hospital deaths: a pooled analysis.

Hsien Seow, Kevin Brazil, Jonathan Sussman, José Pereira, Denise Marshall, Peter C Austin, Amna Husain, Jagadish Rangrej, Lisa Barbera

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 92 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
92citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

92 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Pooled it
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  15. Impact of the implementation of an embedded palliative care model in the continuum of care for patients with metastatic breast cancer.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025
    Observational
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32 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Hsien SeowDepartment of Oncology, McMaster University, Hamilton, Ontario L8V 5C2, Canada seowh@mcmaster.ca.
Kevin BrazilSchool of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
Jonathan SussmanDepartment of Oncology, McMaster University, Hamilton, Ontario L8V 5C2, Canada.
José PereiraDivision of Palliative Care, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Denise MarshallDepartment of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
Peter C AustinInstitute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Amna HusainDepartment of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
Jagadish RangrejInstitute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Lisa BarberaDepartment of Radiation Oncology, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

Funding

Canadian Institutes of Health Research
6 · The paper itself

Abstract

objectiveTo determine the pooled effect of exposure to one of 11 specialist palliative care teams providing services in patients' homes.

designPooled analysis of a retrospective cohort study.

settingOntario, Canada.

participants3109 patients who received care from specialist palliative care teams in 2009-11 (exposed) matched by propensity score to 3109 patients who received usual care (unexposed).

interventionThe palliative care teams studied served different geographies and varied in team composition and size but had the same core team members and role: a core group of palliative care physicians, nurses, and family physicians who provide integrated palliative care to patients in their homes. The teams' role was to manage symptoms, provide education and care, coordinate services, and be available without interruption regardless of time or day.

main outcome measuresPatients (a) being in hospital in the last two weeks of life; (b) having an emergency department visit in the last two weeks of life; or (c) dying in hospital.

resultsIn both exposed and unexposed groups, about 80% had cancer and 78% received end of life homecare services for the same average duration. Across all palliative care teams, 970 (31.2%) of the exposed group were in hospital and 896 (28.9%) had an emergency department visit in the last two weeks of life respectively, compared with 1219 (39.3%) and 1070 (34.5%) of the unexposed group (P<0.001). The pooled relative risks of being in hospital and having an emergency department visit in late life comparing exposed versus unexposed were 0.68 (95% confidence interval 0.61 to 0.76) and 0.77 (0.69 to 0.86) respectively. Fewer exposed than unexposed patients died in hospital (503 (16.2%) v 887 (28.6%), P<0.001), and the pooled relative risk of dying in hospital was 0.46 (0.40 to 0.52).

conclusionsCommunity based specialist palliative care teams, despite variation in team composition and geographies, were effective at reducing acute care use and hospital deaths at the end of life.

Indexed as

Hospital MortalityPalliative CarePatient Care TeamSpecializationCohort StudiesCommunity Health ServicesEmergency Service, HospitalHospitalizationHumansRetrospective Studies

Identifiers

PMID24906901
PMCPMC4048125

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.