1. © Nuffield Trust November 2012 Evaluating the impact of the Marie Curie Nursing Service Xavier Chitnis, Theo Georghiou, Adam Steventon and Martin Bardsley

2. © Nuffield Trust 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

3. © Nuffield Trust 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

4. © Nuffield Trust 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

5. © Nuffield Trust Place of death for Marie Curie patients and matched controls

6. © Nuffield Trust Proportion of deaths at home for Marie Curie patients and matched controls, by history of cancer

7. © Nuffield Trust Proportion of Marie Curie patients and controls who used hospital care after the index date

8. © Nuffield Trust Number of emergency admissions per 1,000 people by day over the last three months of life

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

10. © Nuffield Trust Post-index date average hospital costs for Marie Curie patients and matched controls

11. © Nuffield Trust Difference in adjusted hospital costs per person between Marie Curie patients and controls, by history of cancer

12. © Nuffield Trust 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

13. © Nuffield Trust 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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