Methodology

Name

Percentage of people who died in the community in Ontario and who received physician home visit(s) and/or palliative home care in the last 90 days of life.

Description

This indicator measures the proportion of people who received palliative care at home at the end of life.

Numerator

The number of non-institutionalized people who died in the community in Ontario who received at least one palliative home care service or any physician home visit within their last 90 days of life.

Denominator

Number of non-institutionalized people who died in the community in Ontario, in a fiscal year.

Exclusion Criteria

Excludes patients who were in an institution for their last 90 days of life. The purpose is to exclude people who died who were admitted to an institution for the duration of the period of study and would thus not be eligible to receive home care services nor physician home visits.

The types of institutions included are:

• inpatient acute hospitals
• inpatient mental health
• complex continuing care
• inpatient rehabilitation
• long-term care

People who died are determined to have been within the institution in their last 90 days of life as follows:

• If the total length of stay of a person, across all institutions’ data sources is less than the timeframe being considered, then the person is considered living in the community. Otherwise the person is considered to have been in an institution for the duration of time under consideration.

Data Sources

• Decedent Cohort
• Health Shared Services Ontario (now part of Ontario Health) Home Care Database
• Discharge Abstract Database
• OHIP Claims History Database
• Continuing Care Reporting System (long-term care, complex continuing care)
• Inpatient Mental Health (Ontario Mental Health Reporting System)
• Inpatient Rehabilitation (National Rehabilitation Reporting System)

Caveats and Limitations

• The data doesn't include information on the quality of the care, clinical details, health care needs, preferences and appropriateness of the house call.
• The data shows the number of patients on palliative care caseload that had at least one house call. For improvement purposes, a provincial target has been set for the percentage of people who died in Ontario who received physician visits at home and/or palliative home care services in their last 90 days of life. Yet, there is no evidence to establish the appropriate number of house calls for comparison.
• The indicator doesn't capture home visits with other providers.
• The data doesn't show information on the details and quality of the home care, health care needs, preferences and appropriateness of the care.
• The data shows the number of patients on palliative care caseload that had at least one home care service, which may not be sufficient. For improvement purposes, a provincial target has been set for the percentage of people who died in Ontario who received physician visits at home and/or palliative home care services in their last 90 days of life. Yet, there is no evidence to establish the appropriate amount or mix of home care services for patients on the palliative care caseload for comparison.
• The data does not show if patients on palliative care caseload had any other support or a caregiver.

Name

Percentage of people who died in Ontario who had one or more unplanned emergency department visits in their last 30 days of life.

Description

This indicator measures the percentage of people who died in Ontario who had one or more unplanned emergency department visits in their last 30 days of life.

Numerator

The number of people in Ontario who died in reporting period who had one or more unplanned emergency department visits in their last 30 days of life.

Denominator

Number of people in Ontario who died in reporting period who were not in an acute care hospital in the last 30 days of life.

Exclusion Criteria

Excludes patients who were hospitalized in an acute care facility for the last 30 days of life.

If the sum of all episodes of care in acute care facilities during the last 30 days of life equals 30 days, the patient is considered hospitalized for the duration of interest, and is excluded.

Data Sources

• Decedent Cohort
• National Ambulatory Care Reporting System
• Discharge Abstract Database

Caveats and Limitations

The data doesn't include information on the quality of the care, clinical details, health care needs, preferences and appropriateness of the emergency room care.

Name

Percentage of people in Ontario who died in hospital.

Description

This indicator measures the proportion of people who died in hospital (inpatient, emergency department, complex continuing care, rehabilitation).

Numerator

The number of people who died in hospital during the reporting period.

Hospital includes the following facilities:

• Acute inpatient hospitals
• Emergency departments 
• Inpatient mental health
• Complex continuing care 
• Inpatient rehabilitation

Denominator

Number of people in Ontario who died in the reporting period.

Exclusion Criteria

None

Data Sources

Decedent Cohort

Caveats and Limitations

• The data shows the location of the death, but not the location where care was received before death (i.e., the death may have occurred in the emergency department, but in general the care may have been provided in long-term care).
• No information about the preferred place of death is provided.

When we were developing the Ontario Palliative Care Network Action Plan 1: 2017-2020, Local Health Integration Networks were asked to provide their regional level targets for the fiscal years 2018/19 and 2019/20 based on their current performance and perceived ability to affect them over next three years. The provincial targets as depicted in the data tables were determined based on a weighted average of the Local Health Integration Network targets.

We thank our health system partners for giving Ontario Health (Cancer Care Ontario) permission to use their data to report on system-level measures.

Parts of the system performance reporting on this website are based on data and information compiled and/or provided by the following partners. However, the analyses, conclusions, opinions and statements expressed here are those of the authors, and not necessarily those of our partner organizations:

• ICES (formerly Institute for Clinical Evaluative Sciences)
• Canadian Institute for Health Information
• Ministry of Health
• Health Shared Services Ontario (now part of Ontario Health)