INDICATOR NAME
Name
Home care services in the last 30 days of life
Alternate Name
Percentage of people who had at least one home care visit during their last 30 days of life , among people who lived in the community during that period.
INDICATOR DESCRIPTION
Description
This indicator measures the percentage of people, who lived in the community during their last 30 days who received at least one home care service within that period, reported as:
- Any home care
- Palliative home care
A higher percentage is better.
Indicator Status
Active
HQO Reporting tool/product
Public reporting
Dimension
Effective, Timely
Type
Process
DEFINITION AND SOURCE INFORMATION
Unit of Measurement
Percentage
Calculation Methods
Numerator divided by the denominator times 100
Numerator including inclusion/exclusion
Number of people specified in the denominator, who received at least one home care service during their last 30 days of life, reported as:
- Any home care (who had any of the codes listed below)
Inclusions:
Include if the records specify that the decedent had any HCD services based on stated below variable SERVICE except 10 and 14 within 1 month
SERVICE = Type of service provided (home care service)
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| HOMEMAKING SERVICES (HOUR) |
| COMBINED PS AND HM SERVICES (HOUR) |
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| MENTAL HEALTH AND ADDIDCTION NURSING VISIT |
| Nurse Practitioner Palliative Visit |
| Rapid Response Nursing Visit |
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| Health Promotion Education and Symptom Management |
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2. Palliative home care (who had any of the codes listed below)
Home Care Database (HCD):
Service_RPC = 95: Service care goal of end of life; patient provided service under end of life designation OR
For any service record within the 1 month (30 days) , consider it palliative if:
SRC_admission = 95: Service recipient code (i.e., classification) of end of life on admission OR
SRC_discharge = 95: Service recipient code of end of life on discharge
Denominator including inclusion/exclusion
Number of people who died and were in the community in their last 30 days of life.
Exclusions:
- People who spent their last month in the hospital, LTC/CCC or NRS.
- If the sum of the lengths of stay (considering episodes of care within acute inpatient stays) across all institutions during the last 30 days of life equals or exceeds 30 days, the patient is considered in an institution for the duration of interest, and is excluded.
- Institution is defined as: Acute inpatient hospital, Complex Continuing care, Long term care home, Inpatient mental health, Inpatient rehab
2. DAD death records (discharge disposition = 07) that have MCC = 19 (Trauma, injury, poisoning, toxic effect of drugs)
NACRS death records (VISIT_DISPOSITION = '10', '11') where any diagnosis code begins with one of the following: 'S', 'T', 'V', 'W', 'X', 'Y' (sudden deaths)
OMHRS death records (x90 = 2 or 3) where x90 = 2 (suicide)
Adjustment (risk, age/sex standardization)- detailed
None
Data Source
Continuing Care Reporting System (CCRS), Discharge Abstract Database (DAD), Home Care Database (HCD), National Ambulatory Care Reporting System (NACRS), National Rehabilitation Reporting System (NRS), Ontario Mental Health Reporting System (OMHRS), Postal Code Conversion File Plus (PCCF+), Registered Persons Database (RPDB)
Data provided to HQO by
Cancer Care Ontario (CCO)
Reported Levels of comparability /stratifications (defined)
Income, Region, Rurality, Sex, Time
OTHER RELEVANT INFORMATION
Caveats and Limitations
- The data don’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 people who had at least one home care service, which may not be sufficient There is no evidence of what is the appropriate amount or mix of home care services to which this could be compared.
- The data do not show if people had any other home support or a caregiver.
Comments Detailed
This indicator aligns with the palliative care QS overarching and the OPCN system level indicators.
Footnotes
1. Dudevich A, Chen A, Gula C, Fagbemi J. End-of-life hospital care for cancer patients: an update. Healthc Q. Toronto (ON). 2013 Dec;17(3):8-10.
2. Tanuseputro P, Beach S, Chalifoux M, Wodchis W, Hsu A, Seow H, et al. Effect of physician home visits for the dying on place of death. [Under publication].
3. Brumley R, Enguidanos S, Jamison P, Seitz R, Morgenstern N, Saito S, McIlwane J, Hillary K, Gonzalez J. Increased satisfaction with care and lower costs: results of a randomized trial of in‐home palliative care. J Am Geriatr Soc. 2007 Jul 1;55(7):993-1000.
4. Hodgson C. Cost-effectiveness of palliative care: A review of the literature. Prepared for Canadian Hospice Palliative Care Association. Ottawa (ON). [Date unknown]. Available from: http://hpcintegration.ca/media/24434/TWF-Economics-report-Final.pdf
TAGS
Sector
Home Care
Type
Process
Topic
End-of-life / Palliative
Dimension
Effective, Timely
Source
Continuing Care Reporting System (CCRS), Discharge Abstract Database (DAD), Home Care Database (HCD), National Ambulatory Care Reporting System (NACRS), National Rehabilitation Reporting System (NRS), Ontario Mental Health Reporting System (OMHRS), Postal Code Conversion File Plus (PCCF+), Registered Persons Database (RPDB)
PUBLISH
Publish Datetime
20/11/2018 15:47:00