Association of primary and community care services with emergency visits and hospital admissions at the end of life in people with cancer: A retrospective cohort study

Abstract

Objective To examine the association between primary and community care use and measures of acute hospital use in people with cancer at the end of life. Design Retrospective cohort study. Setting We used Discover, a linked administrative and clinical data set from general practices, community and hospital records in North West London (UK). Participants People registered in general practices, with a diagnosis of cancer who died between 2016 and 2019. Primary and secondary outcome measures ≥3 hospital admissions during the last 90 days, ≥1 admissions in the last 30 days and ≥1 emergency department (ED) visit in the last 2 weeks of life. Results Of 3581 people, 490 (13.7%) had ≥3 admissions in last 90 days, 1640 (45.8%) had ≥1 admission in the last 30 days, 1042 (28.6%) had ≥1 ED visits in the last 2 weeks; 1069 (29.9%) had more than one of these indicators. Contacts with community nurses in the last 3 months (≥13 vs <4) were associated with fewer admissions in the last 30 days (risk ratio (RR) 0.88, 95% CI 0.90 to 0.98) and ED visits in the last 2 weeks of life (RR 0.79, 95% CI 0.68 to 0.92). Contacts with general practitioners in the last 3 months (≥11 vs <4) was associated with higher risk of ≥3 admissions in the last 90 days (RR 1.63, 95% CI 1.33 to 1.99) and ED visits in the last 2 weeks of life (RR 1.27, 95% CI 1.10 to 1.47). Conclusions Expanding community nursing could reduce acute hospital use at the end of life and improve quality of care.