Comparison of prospective and retrospective indicators of the quality of end-of-life cancer care.
OBJECTIVE
To compare prospectively and retrospectively defined benchmarks for the quality of end-of-life care, including a novel indicator for the use of opiate analgesia.


METHODS
Linked claims and cancer registry data from 1994 to 2003 for New Jersey and Pennsylvania were used to examine prospective and retrospective benchmarks for seniors with breast, colorectal, lung, or prostate cancer who participated in state pharmaceutical benefit programs.


RESULTS
Use of opiates, particularly long-acting opiates, was low in both the prospective and retrospective cohorts (9.1% and 10.1%, respectively), which supported the underuse of palliative care at the end-of-life. Although hospice was used more commonly in the retrospective versus prospective cohort, admission to hospice within 3 days of death was similar in both cohorts (28.8% v 26.4%), as was the rate of death in an acute care hospital. Retrospective and prospective measures identified similar physician and hospital patterns of end-of-life care. In multivariate models, a visit with an oncologist was positively associated with the use of chemotherapy, opiates, and hospice. Patients who were cared for by oncologists in small group practices were more likely to receive chemotherapy (retrospective only) and less likely to receive hospice (both) than those in large groups. Compared with patients who were cared for in teaching hospitals, those in other hospitals were more likely to receive chemotherapy (both) and to have toxicity (prospective) but were less likely to receive opiates (both) and hospice (retrospective).


CONCLUSIONS
Retrospective and prospective measures, including a new measure of the use of opiate analgesia, identify some similar physician and hospital patterns of end-of-life care.
Setoguchi
Soko
S
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120-1613, USA.
Earle
Craig C
CC
Glynn
Robert
R
Stedman
Margaret
M
Polinski
Jennifer M
JM
Corcoran
Colleen P
CP
Haas
Jennifer S
JS
D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D019985:Benchmarking; D004363:Drug Utilization; D005260:Female; D006302:Health Services Research; D006738:Hospices / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data; D006278:Medicare; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D009515:New Jersey; D010166:Palliative Care / Q000706:statistics & numerical data; D010414:Pennsylvania; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011788:Quality of Life; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
D000701:Analgesics, Opioid; D000970:Antineoplastic Agents