Factors Associated with Re-Enrollment of Patients from a Specialist Community Palliative Care Service.

Abstract

<b><i>Objective:</i></b> The aim of this study was to describe the patterns of discharge and re-enrollment to a community palliative care service, and to identify factors associated with re-enrollment. <b><i>Background:</i></b> Community-based palliative care is a limited resource. The evidence base to guide discharge practices from community palliative care services is limited. <b><i>Methods:</i></b> A retrospective audit of the electronic medical records for all patients discharged from the Sacred Heart Community Palliative Care Service (SHCPCS), Sydney, from July 2010 to July 2016 was conducted. Patients were excluded if they were discharged due to death, transferred out of catchment area, declined the service, transferred to another hospital, or were referred inappropriately. Data extracted included sociodemographic variables, living situation, diagnoses, and discharge and re-enrollment details. Using binary logistic regression analysis, predictive factors, including socio-demographic characteristics, diagnosis and length of episode of care, were evaluated. <b><i>Results:</i></b> Of the 739 patients who met the inclusion criteria, 42 (5.7%) were re-enrolled to the service. The median length of the initial episode of care was 65 days and the median timeframe between discharge and re-enrollment was 216 days. Patients living in residential care facilities (odds ratio [OR] 3.45; 95% confidence interval [CI] 1.28-9.28; <i>p</i> = 0.01) and those with malignant diagnoses (OR 2.22; 95% CI 1.00-4.93; <i>p</i> = 0.04) had higher rates of re-enrollment. <b><i>Discussion:</i></b> The proportion of patients re-enrolled to the service was low. Both patient factors and disease factors were associated with re-enrollment. Future prospective studies evaluating prognostic factors to assist with effective discharge processes and guidelines are warranted.