Resumen de Predictors of Place of Death of Individuals in a Home-Based Primary and Palliative Care Program
Phoebe G. Prioleau, Tacara Soones, Katherine Ornstein, Meng Zhang, Cardinale B. Smith, Ania Wajnberg
Objectives To investigate factors associated with place of death of individuals in the Mount Sinai Visiting Doctors Program (MSVD).
Design A retrospective chart review was performed of all MSVD participants who died in 2012 to assess predictors of place of death in the last month of life.
Setting MSVD, a home-based primary and palliative care program in New York.
Participants MSVD participants who were discharged from the program because of death between January 2012 and December 2012 and died at home, in inpatient hospice, or in the hospital (N = 183).
Measurements Electronic medical records were reviewed to collect information on demographic characteristics, physician visits, and end-of-life conversations.
Results Of 183 participants, 103 (56%) died at home, approximately twice the national average; 28 (15%) died in inpatient hospice; and 52 (28%) died in the hospital. Bivariate analyses showed that participants who were white, aged 90 and older, non-Medicaid, or had a recorded preference for place of death were more likely to die outside the hospital. Diagnoses and living situation were not significantly associated with place of death. Multivariate logistic regression analysis showed no statistical association between place of death and home visits in the last month of life (odds ratio = 1.21, 95% confidence interval = 0.52–2.77).
Conclusion Home-based primary and palliative care results in a high likelihood of nonhospital death, although certain demographic characteristics are strong predictors of death in the hospital. For MSVD participants, home visits in the last month of life were not associated with death outside the hospital.
