The organization, delivery and costs of end-of-life cancer care: the potential of homecare nursing in four provinces

When cancer patients are very sick and dying, they need special care. They often visit the hospital to get this special care, but these hospital visits are very expensive. Some people believe that nurses can provide this special care to patients in their own homes so that they do not have to visit the hospital unnecessarily, which might save money. Dr Seow and his team from four provinces will investigate if this belief is true. In other words, do nurses providing special care in the homes of dying patients help to prevent hospital visits? If so, how many nursing hours are needed? The team will also determine if providing more nursing care in the home saves money and if the same is true in all four provinces. Dr Seow has previously studied how dying cancer patients use homecare nursing and hospital care. His past study showed that patients that used more homecare nursing hours were less likely to visit the hospital. This study was limited to cancer patients in Ontario. Dr Seow will use a similar methodology to study this relationship in the other three provinces. Other members of his team have previously studied health care use in dying cancer patients and have created methods to calculate the total costs of the services they use. To compare costs equally, a consistent method to calculate costs will be applied in all four provinces. Dr Seow and his team are studying dying cancer patients in the last year of life across four provinces. They are examining if providing more homecare nursing hours leads to fewer hospital visits. Also, the team is investigating whether more homecare nursing hours leads to lower total costs of health care for each patient and if living in a different province changes how patients use care. To answer these questions the team will use health care billing data that is collected by the government. Patients in the study will have died of cancer between April 1, 2004 and March 31, 2008. A better understanding of the impact of homecare nursing on hospital use and total costs can lead to changes in the way we provide care for dying cancer patients. This study is important to improving how we provide care for dying cancer patients in Canada. Dr Seow and his team will determine if nurses can provide special care in the home so that patients can avoid unnecessary hospital visits and if so, how many nursing hours are needed. The study will also examine the possible costs saved by providing more home nursing and will examine if and how these relationships are different in the four provinces. Answering these questions is important to improving care and determining the best ways to provide care for dying cancer patients in an affordable manner. The outcomes can influence national and provincial policies that will improve the delivery and quality of care to cancer patients across Canada.