Palliative care delivery across health sectors: A population-level observational study.
Little population-level information exists about the delivery of palliative care across multiple health sectors, important in providing a complete picture of current care and gaps in care.



Provide a population perspective on end-of-life palliative care delivery across health sectors.



Retrospective population-level cohort study, describing palliative care in the last year of life using linked health administrative databases.



All decedents in Ontario, Canada, from 1 April 2010 to 31 March 2012 ( n = 177,817).



Across all health sectors, about half (51.9%) of all decedents received at least one record of palliative care in the last year of life. Being female, middle-aged, living in wealthier and urban neighborhoods, having cancer, and less multi-morbidity were all associated with higher odds of palliative care receipt. Among 92,276 decedents receiving palliative care, 84.9% received care in acute care hospitals. Among recipients, 35 mean days of palliative care were delivered. About half (49.1%) of all palliative care days were delivered in the last 2 months of life, and half (50.1%) had palliative care initiated in this period. Only about one-fifth of all decedents (19.3%) received end-of-life care through publicly funded home care. Less than 10% of decedents had a record of a palliative care home visit from a physician.



We describe methods to capture palliative care using administrative data. Despite an estimate of overall reach (51.9%) that is higher than previous estimates, we have shown that palliative care is infrequently delivered particularly in community settings and to non-cancer patients and occurs close to death.
1 Bruyère Centre for Learning, Research and Innovation in Long-Term Care, Bruyère Research Institute, Ottawa, ON, Canada.|2 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Hospital-Civic Campus, Ottawa, ON, Canada.
Peter
P
Tanuseputro
3 Institute for Health Policy, Management and Evaluation, University of Toronto, ON, Canada.
Suman
S
Budhwani
3 Institute for Health Policy, Management and Evaluation, University of Toronto, ON, Canada.
Yu Qing
YQ
Bai
3 Institute for Health Policy, Management and Evaluation, University of Toronto, ON, Canada.|4 Primary Care & Population Health, Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada.
Walter P
WP
Wodchis
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D064887:Observational Studies as Topic; D009864:Ontario; D010166:Palliative Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D011159:Population Surveillance; D012189:Retrospective Studies; D012737:Sex Factors; D013727:Terminal Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D055815:Young Adult
Palliative care; cancer; end-of-life care; home care services; house calls; palliative medicine