Towards using administrative databases to measure population-based indicators of quality of end-of-life care: testing the methodology

Abstract

This study is concerned with methods to measure population-based indicators of quality end-oflife care. Using a retrospective cohort approach, we assessed the feasibility, validity and reliability of using administrative databases to measure quality indicators of end-of-life care in two Canadian provinces. The study sample consisted of all females who died of breast cancer between 1 January 1998 and 31 December 2002, in Nova Scotia or Ontario, Canada. From an initial list of 19 quality indicators selected from the literature, seven were determined to be fully measurable in both provinces. An additional seven indicators in one province and three in the other province were partially measurable. Tests comparing administrative and chart data show a high level of

Comparing Enrolees with Non-Enrolees of Cancer-Patient Navigation at End of Life

“…Those outcomes were selected because, in prior studies, a shorter interval from diagnosis to death [16][17][18][19]22,23 and in-hospital death 18,20,21 were indicators of lower rates of access to out-of-hospital palliative support. Other outcome indicators of the quality of community-based palliative care at end of life are timely enrolment in specialized palliative care 16,20,23 , no or few days in hospital in the last month of life 18,22 , and minimal use of the emergency department [18][19][20][21][22] . Receiving palliative radiation [16][17][18][19][20]23 and home care [20][21][22] have also been used as indicators of quality end-of-life care.…”

“…Other outcome indicators of the quality of community-based palliative care at end of life are timely enrolment in specialized palliative care 16,20,23 , no or few days in hospital in the last month of life 18,22 , and minimal use of the emergency department [18][19][20][21][22] . Receiving palliative radiation [16][17][18][19][20]23 and home care [20][21][22] have also been used as indicators of quality end-of-life care. Access to, and continuity of, primary care, the use of medical oncology and chemotherapy [18][19][20]22 , and being a nursing home resident 19,23,30 are also relevant.…”

“…Receiving palliative radiation [16][17][18][19][20]23 and home care [20][21][22] have also been used as indicators of quality end-of-life care. Access to, and continuity of, primary care, the use of medical oncology and chemotherapy [18][19][20]22 , and being a nursing home resident 19,23,30 are also relevant. Socioeconomic and distance indicators of inequity should be investigated by linking the postal code of residence at death to census data 17,19,22,23,45 because a meta-analysis showed that the benefit from navigation is greatest for the most vulnerable individuals 46 .…”

“…Although few studies of navigation in relation to palliative and end-of-life care have been reported 5,8 , the population-based study design for investigating care for people at the end of life has been well established in Nova Scotia and elsewhere [16][17][18][19][20][21][22][23] . Nova Scotia is therefore an ideal setting to investigate use of navigation by people with cancer who are in their last phase of life.…”

Use of Opioid Analgesics Among Older Persons With Colorectal Cancer in Two Health Districts With Palliative Care Programs

“…Adequate pain control and dying in the preferred location are characteristics of quality palliative care 41,42 and of a "good death." 43,44 We found that enrollment in a PCP was associated with filling an opioid prescription in the community.…”