evaluating the impact of the marie curie nursing service
DESCRIPTION
This slideshow illustrates the findings of a Nuffield Trust study commissioned by Marie Cure Cancer Care, which looked at the impact of the Marie Curie Nursing Service on allowing people to die in a place of their choosing, and on the use and costs of hospital care at the end of life.TRANSCRIPT
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© Nuffield Trust November 2012
Evaluating the impact of the Marie Curie Nursing Service
Xavier Chitnis, Theo Georghiou, Adam Steventon and Martin Bardsley
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© Nuffield Trust
Summary
• Aim: To evaluate the impact of Marie Curie Nursing Service care on place of death, and hospital use and cost
• Method: Compared a large cohort of people who received Marie Curie Nursing Service care with matched controls
• Results: People who received Marie Curie Nursing Service care were (compared to those receiving ‘standard’ care):
• significantly more likely to die at home • less likely to use all forms of hospital care
• Discussion: Study provides evidence that home-based nursing care can reduce hospital use at end of life, and help more people die at home
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© Nuffield Trust
Background
• 53% of deaths in hospital in England in 2010, with only 21% of deaths at home
• Surveys suggest majority of people would prefer to die at home
• Marie Curie Nursing Service:
• Home-based end-of-life nursing care since 1958
• Most people receive 9-hour day or overnight care
• End of life care for ~28,000 people annually
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© Nuffield Trust
Methods
• Sample
• 29,538 people who received MCNS care from January 2009
to November 2011
• Sophisticated matching techniques used to select 29,538
individually matched controls from those who died in
England from January 2009 to November 2011
• Matched on demographic, clinical and prior hospital use
variables
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© Nuffield Trust
Place of death for Marie Curie patients and matched controls
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© Nuffield Trust
Proportion of deaths at home for Marie Curie patients and matched controls, by history of cancer
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Proportion of Marie Curie patients and controls who used hospital care after the index date
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© Nuffield Trust
Number of emergency admissions per 1,000 people by day over the last three months of life
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© Nuffield Trust
Number of emergency admissions per 1,000 people by day over the last three months of life (continued)
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© Nuffield Trust
Post-index date average hospital costs for Marie Curie patients and matched controls
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© Nuffield Trust
Difference in adjusted hospital costs per person between Marie Curie patients and controls, by history of cancer
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© Nuffield Trust
Conclusions
• Evaluation of large-scale, existing end-of-life care service using well-matched controls
• Those who received home-based nursing care: • are much more likely to die at home • have lower use of hospital care • have lower hospital costs
• Impact of Marie Curie Nursing Service care is greater for those without cancer – a surprising finding, although literature limited
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© Nuffield Trust
Conclusions (continued)
• Caveats: • Other costs – reduction in hospital costs considered against
other costs (including the Marie Curie Nursing Service) and possible increased used of other services (e.g. GPs, community services and social care)
• Unobserved confounders – although groups well-matched, there may have been unobserved factors not recorded in routine data influencing suitability for home-based end-of-life care, e.g. personal preferences, availability of family/carer support.
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© Nuffield Trust
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