title: Quality of end-of-life cancer care in Canada: a retrospective four-province study using administrative health care data.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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;
authors.forename: L
authors.initials: L
authors.lastname: Barbera
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON; ; Department of Oncology, McMaster University, Hamilton, ON;
authors.forename: H
authors.initials: H
authors.lastname: Seow
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON;
authors.forename: R
authors.initials: R
authors.lastname: Sutradhar
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON;
authors.forename: A
authors.initials: A
authors.lastname: Chu
authors.affiliation: Department of Family Medicine, Dalhousie University, Halifax, NS;
authors.forename: F
authors.initials: F
authors.lastname: Burge
authors.affiliation: Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton, AB;
authors.forename: K
authors.initials: K
authors.lastname: Fassbender
authors.affiliation: Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC;
authors.forename: K
authors.initials: K
authors.lastname: McGrail
authors.affiliation: Department of Family Medicine, Dalhousie University, Halifax, NS;
authors.forename: B
authors.initials: B
authors.lastname: Lawson
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON;
authors.forename: Y
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Canadian Centre for Applied Research in Cancer Control, BC Cancer Research Centre, Vancouver, BC.
authors.forename: R
authors.initials: R
authors.lastname: Pataky
authors.affiliation: Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton, AB;
authors.forename: A
authors.initials: A
authors.lastname: Potapov
keywords: Palliative care; health services research; quality indicators