© Nuffield Trust November 2012

Evaluating the impact of the Marie Curie Nursing Service

Xavier Chitnis, Theo Georghiou, Adam Steventon and Martin Bardsley

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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

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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

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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

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Place of death for Marie Curie patients and matched controls

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Proportion of deaths at home for Marie Curie patients and matched controls, by history of cancer

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Proportion of Marie Curie patients and controls who used hospital care after the index date

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Number of emergency admissions per 1,000 people by day over the last three months of life

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Number of emergency admissions per 1,000 people by day over the last three months of life (continued)

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Post-index date average hospital costs for Marie Curie patients and matched controls

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Difference in adjusted hospital costs per person between Marie Curie patients and controls, by history of cancer

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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

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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.

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