{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T19:07:31Z","timestamp":1781204851064,"version":"3.54.1"},"reference-count":39,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"unspecified","delay-in-days":130,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1478951526102491_sec1a\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although home is frequently the preferred place of death, little is known regarding how home healthcare (HHC) influences this outcome for people with dementia (PWD), particularly within Asian contexts. This study investigates the impact of HHC and its 2016 \u201cIntegrated Home-Based Medical Care\u201d reform on home death in Taiwan, explicitly accounting for the cultural phenomenon of \u201cimpending death discharge.\u201d<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526102491_sec2b\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This nationwide retrospective cohort study utilized Taiwan\u2019s National Health Insurance Research Database. We identified PWD decedents from 2011 to 2022 and conducted a nested case\u2013control analysis. Cases (home deaths) and controls (hospital deaths) were matched 1:1 using propensity scores to balance demographics and health status. HHC models included pre-2016 primary HHC, post-2016 primary HHC, and the reformed \u201cHBPC Plus\u201d (Home-Based Primary Care Plus). The outcome was adjusted to include patients discharged terminally to die at home, reflecting distinctive cultural practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526102491_sec3c\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 209,468 decedents, 95,594 were selected after matching. Overall, HHC use was associated with higher odds of home death (adjusted odds ratio [aOR]: 1.17; 95% CI: 1.13\u20131.21). The reformed HBPC Plus program showed the strongest association compared to pre-2016 primary HHC (aOR: 1.63; 95% CI: 1.34\u20131.98). Crucially, this association strengthened further when accounting for impending death discharge (aOR: 1.82; 95% CI: 1.40\u20132.35). Higher visit frequency and services from hospital-based teams were also significantly linked to home death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526102491_sec4d\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HHC significantly increases the likelihood of home death among PWD in culturally influenced contexts. The 2016 reform, particularly the HBPC Plus program, proved highly effective. Policy components like flexible visit frequencies and enhanced hospital\u2013physician coordination appear vital for supporting end-of-life care at home, offering key insights for policy planning in aging societies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1478951526102491","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T07:07:33Z","timestamp":1778483253000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Impact of home healthcare reform on place of death for people with dementia: A nationwide cohort study accounting for cultural factors of impending death discharge"],"prefix":"10.1017","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7157-2137","authenticated-orcid":false,"given":"Chia-Hung","family":"Chen","sequence":"first","affiliation":[{"name":"Far Eastern Memorial Hospital"},{"name":"Fu Jen Catholic University, New Taipei City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth L.","family":"Sampson","sequence":"additional","affiliation":[{"name":"Whipps Cross Hospital, Barts Health NHS Trust"},{"name":"Wolfson Institute of Population Health, Queen Mary University of London"},{"name":"Royal London Hospital, East London Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Yu","family":"Liao","sequence":"additional","affiliation":[{"name":"National Taiwan Normal University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Han","family":"Ho","sequence":"additional","affiliation":[{"name":"Chi-Mei Medical Center"},{"name":"Southern Taiwan University of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Zhe","family":"Tseng","sequence":"additional","affiliation":[{"name":"Kaohsiung Medical University Hospital, Kaohsiung Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Petersen","sequence":"additional","affiliation":[{"name":"University College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chi","family":"Wang","sequence":"additional","affiliation":[{"name":"Far Eastern Memorial Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chen","family":"Lai","sequence":"additional","affiliation":[{"name":"An Nan Hospital, China Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Han","family":"Chen","sequence":"additional","affiliation":[{"name":"An Nan Hospital, China Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung-Yi","family":"Chiou","sequence":"additional","affiliation":[{"name":"Institute of Population Health Sciences, National Health Research Institutes"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao A.","family":"Hsiung","sequence":"additional","affiliation":[{"name":"Institute of Population Health Sciences, National Health Research Institutes"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Ju","family":"Yu","sequence":"additional","affiliation":[{"name":"Taiwan Society of Home Health Care"},{"name":"Home Clinic Dulan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Ritchie","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital and Harvard Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping-Jen","family":"Chen","sequence":"additional","affiliation":[{"name":"Kaohsiung Medical University Hospital, Kaohsiung Medical University"},{"name":"Kaohsiung Medical University"},{"name":"National Health Research Institutes"},{"name":"National Sun Yat-sen 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Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e139"}}