Predicting deaths – estimating the proportion of deaths that are ‘unexpected’

Blackmore, Steven H.; Verne, Julia; Pring, Andy

doi:10.1136/bmjspcare-2011-000053.140

Cited by 8 publications

(11 citation statements)

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“…It is difficult (and not feasible with administrative data) to identify which deaths can be classified as sudden–enough so that a physician home visit could not be reasonably conducted. [ 39 ] Second, palliative care unit (PCU) beds within a hospital setting are poorly tracked in Ontario, and we were thus unable to separate deaths in these settings, likely a small minority of all deaths. [ 23 ] It is unclear to what degree physician home visits facilitate deaths in a PCU bed (i.e., when symptoms are unmanageable at home), or prevent hospitalizations that lead to death in a PCU.…”

Section: Discussionmentioning

confidence: 99%

Associations between physician home visits for the dying and place of death: A population-based retrospective cohort study

et al. 2018

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BackgroundWhile most individuals wish to die at home, the reality is that most will die in hospital.AimTo determine whether receiving a physician home visit near the end-of-life is associated with lower odds of death in a hospital.DesignObservational retrospective cohort study, examining location of death and health care in the last year of life.Setting/ParticipantsPopulation-level study of Ontarians, a Canadian province with over 13 million residents. All decedents from April 1, 2010 to March 31, 2013 (n = 264,754)ResultsMore than half of 264,754 decedents died in hospital: 45.7% died in an acute care hospital and 7.7% in complex continuing care. After adjustment for multiple factors–including patient illness, home care services, and days of being at home–receiving at least one physician home visit from a non-palliative care physician was associated with a 47% decreased odds (odds-ratio, 0.53; 95%CI: 0.51–0.55) of dying in a hospital. When a palliative care physician specialist was involved, the overall odds declined by 59% (odds ratio, 0.41; 95%CI: 0.39–0.43). The same model, adjusting for physician home visits, showed that receiving palliative home care was associated with a similar reduction (odds ratio, 0.49; 95%CI: 0.47–0.51).ConclusionLocation of death is strongly associated with end-of-life health care in the home. Less than one-third of the population, however, received end-of-life home care or a physician visit in their last year of life, revealing large room for improvement.

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Section: Discussionmentioning

confidence: 99%

Associations between physician home visits for the dying and place of death: A population-based retrospective cohort study

et al. 2018

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“…Only 6.5% of Canadian deaths in 2011 were due to external causes; 34 it is difficult to estimate the proportion in the population dying unexpectedly, with one previous study in the United Kingdom putting an estimate of 25%. 35 Partly offsetting our underestimation of the reach of palliative care is our lack of data (aside from physician services) for hospice palliative care; about 2500 of Ontarians die yearly in hospices, or about 3% of all deaths.…”

Section: Discussionmentioning

confidence: 99%

Palliative care delivery across health sectors: A population-level observational study

et al. 2016

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Background:Little population-level information exists about the delivery of palliative care across multiple health sectors, important in providing a complete picture of current care and gaps in care.Aim:Provide a population perspective on end-of-life palliative care delivery across health sectors.Design:Retrospective population-level cohort study, describing palliative care in the last year of life using linked health administrative databases.Setting/participants:All decedents in Ontario, Canada, from 1 April 2010 to 31 March 2012 (n = 177,817).Results:Across all health sectors, about half (51.9%) of all decedents received at least one record of palliative care in the last year of life. Being female, middle-aged, living in wealthier and urban neighborhoods, having cancer, and less multi-morbidity were all associated with higher odds of palliative care receipt. Among 92,276 decedents receiving palliative care, 84.9% received care in acute care hospitals. Among recipients, 35 mean days of palliative care were delivered. About half (49.1%) of all palliative care days were delivered in the last 2 months of life, and half (50.1%) had palliative care initiated in this period. Only about one-fifth of all decedents (19.3%) received end-of-life care through publicly funded home care. Less than 10% of decedents had a record of a palliative care home visit from a physician.Conclusion:We describe methods to capture palliative care using administrative data. Despite an estimate of overall reach (51.9%) that is higher than previous estimates, we have shown that palliative care is infrequently delivered particularly in community settings and to non-cancer patients and occurs close to death.

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“…The sample was a retrospective cohort of people who died between 1 September 2011 and 29 February 2012 in North Somerset and Somerset and whose deaths were expected and potentially eligible for end-of-life care according to criteria derived by the UK National End of Life Care Intelligence Network. 4 Quantitative data on use of Delivering Choice services were collected and linked via NHS number, age and postcode by National Health Service analysts to the Primary Care Mortality Database, in-patient hospital data and ED data obtained from NHS Connecting for Health. All patient data were pseudonymised during linkage.…”

Section: Methodsmentioning

confidence: 99%

Impact of the Marie Curie Cancer Care Delivering Choice Programme in Somerset and North Somerset on place of death and hospital usage: a retrospective cohort study

Purdy

Lasseter

Griffin

et al. 2014

BMJ Support Palliat Care

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ObjectivesThe Marie Curie Cancer Care Delivering Choice Programme (DCP) aims to help palliative patients be cared for in their place of choice. In this study, new palliative care services delivered in two counties in England included end-of-life care coordination centres, an out-of-hours telephone line and discharge in-reach nurses. The study aimed to investigate the impact of DCP on place of death and hospital usage (emergency department (ED) and admissions).MethodsRetrospective cohort of all eligible palliative patients who died over a 6-month period in two counties (n=3594). Participants were those who died of conditions considered to be eligible for end-of-life care, as defined by the Public Health England National End of Life Care Intelligence Network. The sample included people who did and did not access DCP services. DCP service, hospital admission and ED use data, demographic and death data were collected on all eligible participants. Data were analysed using descriptive statistics and logistic regression.ResultsAfter adjusting for potential confounders, those using Delivering Choice were at least 30% less likely to die in hospital or have an emergency hospital admission or ED visit in the last 30 or 7 days of life than those who did not.ConclusionsRecipients of DCP services were less likely to die in or use hospital services. Those considering new ways of providing end-of-life care could explore the possibility of adopting similar services and evaluating the outcomes from patient, carer and system perspectives.

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Predicting deaths – estimating the proportion of deaths that are ‘unexpected’

Abstract: ACPEL Abstracts and associated service provision as it can be assumed that 75% of all deaths in England and Wales are predictable to some extent and suitable for inclusion on End of Life Care registers.

Cited by 8 publications

References 0 publications

Associations between physician home visits for the dying and place of death: A population-based retrospective cohort study

Associations between physician home visits for the dying and place of death: A population-based retrospective cohort study

Palliative care delivery across health sectors: A population-level observational study

Impact of the Marie Curie Cancer Care Delivering Choice Programme in Somerset and North Somerset on place of death and hospital usage: a retrospective cohort study

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