Unwarranted variations in end-of-life care and the impact of using an electronic coordination system.

This study looks at the variations in end-of-life care in North-East Essex (eastern England) combining hospital records, official death records and the local electronic end-of-life coordination tool. These differences included dying in hospital (versus a general wish to die in the usual place of residence), and inequity in care provision: the place of death varying according to the cause of death (even for highly predictable conditions); and deprivation being associated with a greater likelihood of dying in hospital. There was a positive correlation between the use of an electronic end-of-life coordination system and dying in the preferred place of care. The results suggest two actions for policy makers. First, look at variations in end-of-life care so that areas of need can be identified. Second, use of an electronic end-of-life coordination tool is correlated with a reduction in unwarranted variation in the place of death.