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[Accessibility of home palliative care and place of death of cancer patients: data analysis of the Emilia-Romagna Region.]

INTRODUCTION
The ANT Foundation is one of the main non-profit organizations providing palliative care in Italy. For more than 30 years, it has developed a comprehensive home palliative care program for cancer patients predominately active in the Bologna province. One of its main achievements has allowed for the majority of patients to be assisted at home during the last weeks of their lives until time of death. The purpose of the present study is to evaluate the possible impact of the ANT program on health data relating to the location of where cancer patients die within the Local Health Care system area (AUSL) of Bologna, compared to what happens in the other AUSLs of the Emilia-Romagna Region (ERR) where it is not present.


METHODS
Regional cancer mortality data in 2005, 2010 and 2015, according to place of death and AUSL, were obtained by consulting the RER database. Data on patients assisted in the same time periods by the ANT program in the Bologna AUSL area were extracted from the ANT Foundation database and analyzed for place of death.


RESULTS
In the year 2015, 2965 cancer patients died in the Bologna AUSL area. Compared to other AUSL areas of the ERR, it presents with a lower hospital mortality rate (31.2% vs. 47.5%) and a higher home mortality rate (32.8% vs. 19.6%). On the other hand, in 2015 the ANT program had assisted almost 50% of the total number of cancer patients who died in the Bologna AUSL area. Out of these patients, 64.6% died at home, while only 18.7% and 16.6% died in hospital and hospice, respectively. Conversely, hospital and home mortality rates in patients of the Bologna AUSL area who were not assisted by the ANT program, did approximate the mean values of the other ERR AUSLs. Over the 2005-2015 time span, the home mortality rate in the ANT patient series remained about twice as high as those of the Bologna AUSL.


CONCLUSIONS
The comprehensive home palliative care program of the ANT Foundation seems to have a strong impact in determining the reduced hospital mortality rate of the Bologna AUSL area when compared to the other AUSLs of the Emilia-Romagna Region. The extension of this model of comprehensive home-based palliative care to other areas could contribute to reduce the high hospital mortality rate of cancer patients in this Italian Region.