The impact of municipal healthcare setting on the quality of end-of-life care: a population-based cohort study.

BACKGROUND

In Sweden, approximately half of all individuals who die receive municipal care prior to death. Access to high-quality palliative care remains unequal, with known disparities between both care settings and diagnostic groups. Individuals receiving municipal home care are at higher risk of acute hospital admissions and in hospital death than those in long-term care facilities. However, the impact of municipal care setting on the quality of end-of-life care is largely unknown. The aim of this study was to describe the impact of care setting on the quality of end-of-life care among patients receiving municipal healthcare services.

METHOD: This population-based cohort study included all individuals reported during 2023-2024 in the Swedish Register for Palliative Care as recipients municipal palliative care during the last week of life (n = 50,219). Associations between care setting (ordinary housing, and long- and short-term care facilities) and end-of-life quality indicators were analyzed using modified Poisson regression to estimate risk ratios (RR) with 95% confidence intervals. Analyses were adjusted for age, sex, and cause of death.

RESULTS

Compared to individuals receiving care in ordinary housing, those in long- and short-term care were more likely to receive symptom assessments ([RR; 95% CI] 1.14; 1.09-1.19 vs. 1.08; 1.03-1.13). However, they were less likely to receive end-of-life information ([RR; 95% CI] 0.92; 0.91-0.94 vs. 0.98; 0.97-0.99), bereavement support for relatives ([RR; 95% CI] 0.98; 0.97-0.99 vs. 0.95; 0.94-0.96), and external pain consultations ([RR; 95% CI] 0.52; 0.49-0.57 vs. 0.81; 0.76-0.88).

CONCLUSIONS

Care setting influences the quality of municipal end-of-life care. Strengths and weaknesses vary across settings, highlighting the need for targeted quality improvement efforts.