Abstract
INTRODUCTION: The primary objective was to examine the association between unplanned physician-led home visits and patient complexity, as measured by the Minnesota Complexity Assessment Method (MCAM), and between mortality and patient complexity. The secondary objective was to investigate the relationship between patient complexity and patients' wishes to die at home, families' acceptance of the patients' deaths at home, and the location of death. METHODS: We applied Cox proportional hazards models to estimate cause-specific hazard ratios (HRs) for patient complexity, with unplanned home visits and deaths as dependent variables. We employed multinomial logistic regression models to evaluate relative risk ratios (RRRs) of patient complexity, with the patient's wish to die at home, the family's acceptance of the patient's death at home, and the location of death as dependent variables. RESULTS: A total of 712 participants were included in the analysis. The Illness domain of the MCAM was positively associated with unplanned home visits and deaths (adjusted HRs: 1.20 and 1.21, respectively). Furthermore, the Illness domain was also positively associated with patients' wishes to die at home (adjusted RRR [aRRR]: 1.24) and families' acceptance of the patients' deaths at home (aRRR: 1.19), whereas the Social domain was negatively associated with these outcomes (aRRRs: 0.81 and 0.84, respectively). CONCLUSION: Patients with higher biomedical and social complexity may require closer clinical attention in physician-led home visit settings, which could help reduce unplanned visits, improve mortality-related outcomes, and enable patients and their families to choose the location of death without restrictions imposed by biopsychosocial factors.