Quality of end-of-life cancer care in Canada: a retrospective four-province study using administrative health care data
Quality of end-of-life cancer care in Canada: a retrospective four-province study using administrative health care data
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DOI：
10.3747/co.22.2636
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发表时间：
2015-10-01
期刊：
影响因子：
2.6
通讯作者：
Potapov, A.
中科院分区：
文献类型：
--
作者：
Barbera, L.;Seow, H.;Potapov, A.
背景比较加拿大各地癌症患者临终关怀(EOL)的数据质量很差。该项目使用相同的队列和定义来评估不列颠哥伦比亚省、艾伯塔省、安大略省和新斯科舍省的EOL护理质量指标。方法这项对2004-2009财年癌症死亡患者进行的回顾性队列研究使用行政卫生保健数据来检查常用的卫生服务质量指标，以及以前被认为对EOL护理质量重要的指标：急诊科使用、住院治疗、重症监护病房入院、化疗、医生出诊、EOL附近的家庭护理访问以及医院死亡。计算了粗税率和标准税率。在每个省，两个独立的多变量Logistic回归模型检验了与接受积极或支持性护理相关的因素。结果总体而言，在确认的200,285名死于疾病的癌症患者中，54%死于医院，不列颠哥伦比亚省的标准化死亡率最低(50.2%)。EOL的急诊科使用率从新斯科舍省的30.7%到安大略省的47.9%不等。在所有患者中，8.7%接受了积极治疗(所有省份都是类似的)，46.3%接受了支持性治疗(范围从新斯科舍省的41.2%到不列颠哥伦比亚省的61.8%)。邻里收入越低，接受支持性护理的可能性越低。解释：我们成功地使用了来自加拿大四个省的行政卫生保健数据，创建了具有共同定义的指标的相同队列。这项工作是加拿大EOL护理领域走向成熟的重要一步。国家一级的数据共享安排将为这一领域今后的工作提供便利。
Background The 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.Results Overall, 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.Interpretation We 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.