The Association Between Home Palliative Care Services and Quality of End-of-Life Care Indicators in the Province of Québec

Context In Canada, governments have increased spending on home care to promote better end-of-life care. In the province of Quebec, Canada, home palliative care (PC) services (HPCS) are provided by Public Local Community-Based Health Care Service providers (Centres Locaux de Services Communautaires [CLSC]) with universal coverage. Accordingly, there should be no regional variations of these services and their effect on quality of end-of-life PC (QEoLPC) indicators. Objectives To test if all the CLSCs provided the same level of HPCS to cancer patients in the province of Quebec, Canada, and the association between level of HPCS and QEoLPC indicators. Methods Characteristics of 52,316 decedents with cancer were extracted from administrative databases between 2003 and 2006. Two gender-specific "adjusted performance of CLSCs in delivering HPCS" models were created using gender-specific hierarchical regression adjusted for patient and CLSC neighborhood characteristics. Using the same approach, the strength of the association between the adjusted performance of CLSCs in delivering HPCS and the QEoLPC indicators was estimated. Results Overall, 27,255 (52.1%) decedents had at least one HPCS. Significant variations in the adjusted performance of CLSC in delivering HPCS were found. Higher performance led to a lower proportion of men having more than one emergency room visit during the last month of life (risk ratio [RR] 0.924; 95% CI 0.867–0.985), and for women, a higher proportion dying at home (RR 2.255; 95% CI 1.703–2.984) and spending less time in hospital (RR 0.765; 95% CI 0.692–0.845). Conclusion Provision of HPCS remained limited in Quebec, but when present, they were associated with improved QEoLPC indicators.