Impact of a hospice rapid response service on preferred place of death, and costs

BMC Palliative Care

Table 6 Costs of services received £2010^b : Comparison of RRS users (N = 247) and non-users (N = 441), by days in the study

Median (inter- quartile range, 75^th – 25^th),	Days in study (time between referral to hospice and death)
Median (inter- quartile range, 75^th – 25^th),	0-2 days		3-14 days		15-30 days		31-60 days		>60 days
Study group	Non-user	User	Non-user	User	Non-user	User	Non-user	User	Non-user	User
Number in group	31	9	76	42	66	52	100	47	168	97
All GP/primarycontacts	65 (65)	65 (120)	120 (123)	123 (117)^a	189 (69)	189 (48)	339 (217)	339 (240)	525 (273)	525 (218)^a
All community contacts	27 (108)	189 (135)^a	0 (133)	302 (375)^a	63 (200)	364 (390)^a	209 (378)	378 (814)^a	331 (773)	737 (777)^a
All acute (hospital) contacts	0 (0)	0 (0)	0 (54)^a	0 (0)	0 (274)	0 (137)	93 (2718)	72 (1700)	1064 (4025)	900 (2943)
All Marie Curie visits	0 (0)	0 (0)	0 (0)	0 (0)^a	0 (0)	0 (0)^a	0 (0)	0 (0)^a	0 (0)	0 (0)^a
All Out-of-hours contacts	0 (0)	0 (0)	0 (0)	0 (41)^a	0 (0)	0 (81)^a	0 (0)	0 (41)^a	0 (33)	0 (122)^a
All hospice contacts, not RRS	90 (324)	90 (45)	504 (2056)	241 (365)	2512(5056)^a	274 (511)	360 (1889)	605 (2919)	1694 (8016)	1172 (5707)
All social services	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)^a	0 (0)	0 (0)	0 (0)	0 (0)
Hospice RRS visits	0 (0)	160 (240)^a	0 (0)	440 (721)^a	0 (0)	380 (951)^a	0 (0)	480 (1161)^a	0 (0)	560 (1181)^a
Total of 8 services	367 (262)	690 (291)^a	1372 (2102)	1548 (1278)	3790 (4409)	2204 (2523)	3809 (6859)	5110 (5461)	7298(11327)	7324 (7951)

^aMann Whitney U test, significantly higher than the other group, p < 0.05
^bUnit costs of health care, inclusive of oncosts and overheads, applied to service utilisation [19]. GP/Primary: GP/nurse surgery consultations £36/£7.75, GP home visits £120. Community: home visit by nurse/long term conditicns or intermediate care team £27/£31.40, telephone call by long term conditions or intermediate care team £10.00. Acute: A&E £114, outpatient consultation £72, day hospital £194, inpatient night £425. Marie Curie health care assistant/nurse visit: £32/£64. Out-of hours: GP/home visit £180 / £40.50, GP telephone advice £33, walk-in clinic £37, ambulance £90. Hospice costs (based on NHS costs following discussion with hospice finance director), inclusive of oncosts and overheads: home visits by consultant/associate director/nurse/physician/associate practitioner/social worker or chaplain/physiotherapist or occupational therapist: £355/£132/£90/£324/£40/£172/£225/£58; outpatient consultations with consultant/nurse/physician/associate practitioner/social worker: £213.40/£28/£140/£5.25/£106.50; inpatient days: £425; day hospice: £194; counselling: £53.25; breathlessness therapy: £38; complementary therapies (varied): £25.75; RRS: £40 per visit (two visits counted when two HCAs attended)

ISSN: 1472-684X