Barbera L, Seow H, Sutradhar R, Chu A, Burge F, Fassbender K, McGrail K, Lawson B, Liu Y, Pataky R, Potapov A
Odette Cancer Centre, Department of Radiation Oncology, Toronto, ON; ; Department of Radiation Oncology, University of Toronto, Toronto, ON; ; Institute for Clinical Evaluative Sciences, Toronto, ON;
Institute for Clinical Evaluative Sciences, Toronto, ON; ; Department of Oncology, McMaster University, Hamilton, ON;
Curr Oncol. 2015 Oct;22(5):341-55. doi: 10.3747/co.22.2636.
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.
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.
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.
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.
加拿大各地癌症患者临终关怀（eol）护理数据的质量较差。本项目采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临终关怀护理的质量指标。
这项对2004 - 2009财年癌症死者的回顾性队列研究使用行政医疗保健数据，以检查常用于评估且先前被确定为对优质临终关怀护理至关重要的医疗服务质量指标：急诊科就诊、住院、重症监护病房收治、化疗、医生上门出诊以及临终前的家庭护理访视，还有在医院死亡情况。计算了粗率和标准化率。在每个省份，分别使用两个多变量逻辑回归模型来研究与接受积极治疗或支持性治疗相关的因素。
总体而言，在确定的200285名死于癌症的患者中，54%在医院死亡，其中不列颠哥伦比亚省此类死亡的标准化率最低（50.2%）。临终时急诊科就诊率从新斯科舍省的30.7%到安大略省的47.9%不等。所有患者中，8.7%接受了积极治疗（在所有省份相似），46.3%接受了支持性治疗（范围：新斯科舍省为41.2%，不列颠哥伦比亚省为61.8%）。邻里收入较低一直与接受支持性治疗的可能性降低相关。
我们成功利用来自加拿大四个省份的行政医疗保健数据创建了具有共同定义指标的相同队列。这项工作是加拿大临终关怀护理领域走向成熟的重要一步。国家级数据共享安排将有助于该领域未来的工作。
