Quality of end-of-life cancer care in Canada: a retrospective four-province study using administrative health care data

Current Oncology

F. Burge⁶  L. Barbera⁴  B. Lawson⁶  K. McGrail⁷  R. Sutradhar¹  K. Fassbender²  R. Pataky⁵  Y. Liu¹  A. Potapov²  H. Seow³  A. Chu¹ 

[1] Institute for Clinical Evaluative Sciences;University of Alberta;Institute for Clinical Evaluative Sciences and McMaster University;Odette Cancer Centre, University of Toronto and Institute for Clinical Evaluative Sciences;BC Cancer Research Centre;Dalhousie University;University of British Columbia

关键词: Palliative care;    quality indicators;    health services research;   

DOI  :  

学科分类：肿瘤学

来源: Multimed, Inc.

【 摘 要 】

BackgroundThe quality of data comparing care at the end of life (eol) in cancer patients across Canada is poor. This project used identical cohorts and definitions to evaluate quality indicators for eol care in British Columbia, Alberta, Ontario, and Nova Scotia. Methods This retrospective cohort study of cancer decedents during fiscal years 2004–2009 used administrative health care data to examine health service quality indicators commonly used and previously identified as important to quality eol care: emergency department use, hospitalizations, intensive care unit admissions, chemotherapy, physician house calls, and home care visits near the eol, as well as death in hospital. Crude and standardized rates were calculated. In each province, two separate multivariable logistic regression models examined factors associated with receiving aggressive or supportive care. ResultsOverall, among the identified 200,285 cancer patients who died of their disease, 54% died in a hospital, with British Columbia having the lowest standardized rate of such deaths (50.2%). Emergency department use at eol   ranged from 30.7% in Nova Scotia to 47.9% in Ontario. Of all patients, 8.7% received aggressive care (similar across all provinces), and 46.3% received supportive care (range: 41.2% in Nova Scotia to 61.8% in British Columbia). Lower neighbourhood income was consistently associated with a decreased likelihood of supportive care receipt. InterpretationWe successfully used administrative health care data from four Canadian provinces to create identical cohorts with commonly defined indicators. This work is an important step toward maturing the field of eol care in Canada. Future work in this arena would be facilitated by national-level data-sharing arrangements.

【 授权许可】

Unknown