home-care-end-of-life-emergency-department-visit

INDICATOR NAME

Name

Emergency Department Visits by Home Care Clients in Last 30 Days of Life

Alternate Name

Home care clients who had an unplanned emergency department visit in last 30 days of life

INDICATOR DESCRIPTION

Description

This is the percentage of publicly funded home care clients, of all ages, who had an unplanned visit to the emergency department in the last 30 days of life. A lower percentage of clients is better. Unplanned visits in the last month of life, which can be an extremely difficult experience for clients, could indicate they did not receive the care they needed in the community.

Indicator Status

Active

HQO Reporting tool/product

Public Reports (annual report, bulletins and theme reports)

Dimension

Effective

Type

Outcome

DEFINITION AND SOURCE INFORMATION

Unit of Measurement

Percentage

Calculation Methods

Numerator divided by the denominator times 100.

Numerator including inclusion/exclusion

The number of decedents specified in the denominator who had at least one unplanned emergency department visit within 30 days before death.

Unscheduled/unplanned ED visits are identified by:
NACRS variables VISITTYPE = [1,2,4] OR SCHEDEDVISIT = N

Where VISITTYPE Values are:
1= Unplanned Emergency Dep visit for a new clinical condition
2 = Unplanned return visit to Emergency Dep for the same clinical condition
3 = Planned return visit to follow-up to the Emergency Dep visit for the same clinical condition
4 = Clients referred for Emergency Department service provider assessment
5 = Clients referred and seen by a non-Emergency Dept service provider SCHEDEDVISIT Values: N = Not scheduled, Y = Scheduled

Denominator including inclusion/exclusion

The number of home care clients who died in the given fiscal year

Exclusions:

Decedents who were in hospital for the entire period of 1 month before death, as people who are in hospital during this time cannot have an unplanned ED visit.

Adjustment (risk, age/sex standardization)- detailed

N/A

Data Source

Home Care Database (HCD), National Ambulatory Care Reporting System (NACRS), PCCF+ version 5k6A, Registered Persons Database (RPDB)

Data provided to HQO by

Institute for Clinical Evaluative Sciences (ICES)

Reported Levels of comparability /stratifications (defined)

Age, Income, Other, Province, Region, Rurality, Sex

OTHER RELEVANT INFORMATION

Caveats and Limitations

Not all emergency department visits are avoidable and do not always represent poor quality care.

Comments Detailed

1) 30 days are subtracted from the end of each fiscal year (i.e., March) to allow for 30 day follow up during the last reported quarter. This is done for results by fiscal year and by fiscal quarter, resulting in the fourth fiscal quarter having smaller counts than the other three quarters.