Abstract

The models of palliative care delivery differ between hospital-based and community-based settings, and there is an increasing focus on home-based approaches to palliative care that emphasize patient-centered outcomes and the efficiency of the healthcare system. This review was intended to summarize evidence comparing between hospital-based and community-based palliative care services. Data were abstracted on the characteristics of the study, patient demographics, types of interventions, and patient outcomes such as survival, place of death, healthcare utilization, and patient-centered outcomes. The synthesis of findings was conducted in narrative form because of the heterogeneity in study design and outcome measures. Twelve studies that involved various healthcare systems and over 90,000 patients were included. Palliative care based in the community was always linked with higher chances of dying at home and lower death rates in the hospital than hospital-based care. In a number of large cohorts, the survival results were either similar or slightly better with community-based care. In the literature, community-based models have been linked to fewer emergency department visits, fewer hospitalizations, and shorter lengths of stay (in the final months of life). Palliative care provided in the community was found to be linked to better end-of-life care outcomes, including less healthcare use and a higher probability of dying at home, and similar survival rates to those of hospital-based care. The findings justify the growth of integrated home-based palliative care models in healthcare systems as a way of improving patient-centered care and maximizing resource use.

Key words: Hospital-based palliative care, community-based palliative care, systematic review, patient outcomes, healthcare utilization