Evaluating the impact of the Marie Curie Nursing Service

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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.

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Evaluating the impact of the Marie Curie Nursing Service

  1. 1. Evaluating the impact of the Marie Curie Nursing Service Xavier Chitnis, Theo Georghiou, Adam Steventon and Martin BardsleyNovember 2012 © Nuffield Trust
  2. 2. 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 © Nuffield Trust
  3. 3. 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 © Nuffield Trust
  4. 4. 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 © Nuffield Trust
  5. 5. Place of death for Marie Curie patients and matched controls © Nuffield Trust
  6. 6. Proportion of deaths at home for Marie Curie patients andmatched controls, by history of cancer © Nuffield Trust
  7. 7. Proportion of Marie Curie patients and controls who usedhospital care after the index date © Nuffield Trust
  8. 8. Number of emergency admissions per 1,000 people by dayover the last three months of life © Nuffield Trust
  9. 9. Number of emergency admissions per 1,000 people by dayover the last three months of life (continued) © Nuffield Trust
  10. 10. Post-index date average hospital costs for Marie Curiepatients and matched controls © Nuffield Trust
  11. 11. Difference in adjusted hospital costs per person betweenMarie Curie patients and controls, by history of cancer © Nuffield Trust
  12. 12. 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 © Nuffield Trust
  13. 13. 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. © Nuffield Trust
  14. 14. www.nuffieldtrust.org.ukSign-up for our newsletterwww.nuffieldtrust.org.uk/newsletterFollow us on Twitter:Twitter.com/NuffieldTrust © Nuffield Trust

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