Access to palliative care by disease trajectory: a population-based cohort of Ontario decedents

Abstract

ObjectivesTo examine access to palliative care between different disease trajectories and compare to other geographic areas.DesignA retrospective population-based decedent cohort study using linked administrative data.SettingOntario, Canada.ParticipantsOntario decedents between 1 April 2010 and 31 December 2012. Patients were categorised into disease trajectories: terminal illness (eg, cancer), organ failure (eg, chronic heart failure), frailty (eg, dementia), sudden death or other.InterventionsReceipt of palliative care services from institutional and community settings, derived from a validated list of palliative care codes from multiple administrate databases.Outcome measuresReceiving any palliative care services in the last year of life (yes/no), intensity (total days) and time of initiation of palliative care, in hospital and community sectors. Multivariable analysis examined the association between disease trajectory and the receipt of palliative care in the last year of life.ResultsWe identified 235 159 decedents in Ontario. In the last year of life, 88% of terminal illness, 44% of organ failure and 32% of frailty decedents accessed at least one palliative care service. Most care was provided during an inpatient hospitalisation. Terminal illness decedents received twice as many palliative care days (mean of 49 days) compared with organ failure and frailty decedents. Patients with terminal illness initiated palliative care median of 107 days before death compared with median of 19 days among those using the US Medicare hospice benefit.ConclusionsTerminal illness decedents are more likely to receive any palliative care, with increased intensity and earlier before death than organ failure or frailty decedents. These data serve as a useful comparison for other countries with similar and different healthcare systems and eligibility criteria.

Five-year risk of admission to long-term care home and death for older adults given a new diagnosis of dementia: a population-based retrospective cohort study

“…However, discussions about advanced care planning -which should incorporate the high likelihood for admission to a longterm care home and death -have several barriers. 36 Studies consistently find that individuals with dementia are far less likely to receive palliative care than individuals with other diseases, [37][38][39][40] which reflects sub optimal endoflife care for patients and may lead to families being unprepared for their loved one's death. 41 Our approach to displaying death rate visually (Figure 3) may be useful for informing conversations between health care providers and persons with dementia.…”

Trends in site of death and health care utilization at the end of life: a population-based cohort study

“…We identified receipt of palliative care using a comprehensive set of diagnostic and billing codes across multiple providers and health care settings, including information contained in the home care (Home Care Database), hospital (Discharge Abstract Database), emergency department (National Ambulatory Care Reporting System), long-term care and complex continuing care (Continuing Care Reporting System) and physician billing (OHIP) databases, consistent with prior studies. 17,18 We estimated health care costs (from the perspective of the health care payer, the Ontario Ministry of Health and Longterm Care) from the health administrative data sets using an established approach for person-level costing. 19,20 This algorithm summarizes costs attributed to several health sectors, OPEN Research for example, inpatient acute care, emergency department visits, complex continuing care and physician services (for details, see Appendix 1, available at www.cmajopen.ca/ content/7/2/E306/suppl/DC1).…”

Inpatient palliative care of people dying in New South Wales hospitals or soon after discharge

“…Inclusion of deaths from all causes, differing methods to identify chronic conditions (diagnosed comorbidity vs cause of death) and different time periods may account for some of this variation. Although our results suggest improvements, there is a notable underrecognition of the palliative care needs of patients with non‐malignant disease . Palliative care should be available to all who are living with a life‐limiting illness, based on patient need rather than diagnosis, noting that generalist palliative care services will be sufficient for some people .…”

“…Increased life expectancy, ageing of the population and greater numbers of people living with complex chronic illnesses have intensified the need for appropriate end‐of‐life care. Although recommendations, in Australia and internationally, suggest that palliative care be available to all patients with a life‐limiting condition, patients with cancer are more likely to receive palliative services and for a longer duration than patients with other life‐limiting conditions . Palliative services also vary according to patient characteristics, especially age …”