The availability, uptake and impact of palliative home care: a population-level study using administrative data
The majority of patients with a chronic life-threatening illness prefer to be cared for and to die at home or in a familiar environment. As such, the development of policies and legislative and other measures to support the provision of palliative care at home has been a major priority for national and supranational legislative bodies.
However, many policy strategies often lack a sufficient evidence base. The present doctoral thesis focuses on evaluating the use, trends in use, factors that influence use, and the impact of using policy measures to support patients and informal caregivers to provide palliative care in the home or community setting in Belgium. Using full-population administrative databases containing information on all decedents in Belgium between 2010 and 2015, we provided insights into these patterns that allow formulating points of improvement, identification of focal groups for policy, but also allow evaluating the societal impact of the measures in terms of quality and costs of care.
Our research showed that several policy measures to support palliative home care exist in Belgium, and that they are effective in reducing possibly inappropriate care and total costs at the end of life when used. Moreover, people who use palliative home care support measures are more likely to die at home compared to those who do not use these measures. However, our population-level findings also reveal that these measures are overall underused, initiated late in the disease trajectory and show little trends over time, mostly so among older people and those who died with dementia.