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INDICATOR NAME
Name
Location of death
Alternate Name
Percentage of people who died in Ontario reported by location of death
 
INDICATOR DESCRIPTION
Description

This indicator measures the proportion of deaths in:

  • Hospital (inpatient, ED, CCC, rehab, inpatient mental health)
  • Long-term care
  • Community (home, residential hospices, retirement homes and assisted living homes)

Indicator Status
Active
HQO Reporting tool/product
Public reporting
Dimension
Effective, Patient-centred
Type
Outcome
 
DEFINITION AND SOURCE INFORMATION
Unit of Measurement
Percentage
Calculation Methods
Numerator divided by the denominator times 100
Numerator including inclusion/exclusion

Number of people who died in each of the following settings:

  • Hospital (inpatient, ED, CCC and rehab)
  • Long-term care home
  • Community (home, residential hospices, retirement homes and assisted living homes)

Inclusions:

  • Hospital deaths are identified by the following codes:
  • Inpatient:  DAD – SDS dischdisp = 07
  • ED: NACRS – Visit disposition = 10 or 11
  • CCC: CCRS discharge_to_facility_type = 11
  • Rehab: NRS dreason=8
  • Deaths in mental health beds (from OMHRS) 

 LTC

  • CCRS-LTC discharge_to_facility_type = 11 

 Community

  • All other deaths not included in one of the above categories

Note: 

Merge the administrative data death lists by health card number to compile a final administrative death list. If one health card number appears in multiple care settings (multiple death records), the following hierarchy based on the care intensity should be used to assign death setting: acute care, Emergency, CCC, Rehabilitation facilities, LTCs. There should only be one record per health card number in the final results. 

Denominator including inclusion/exclusion

Number of people in Ontario who died in each year of interest.

Exclusions:

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), 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)
Age, Income, Region, Rurality, Time
 
OTHER RELEVANT INFORMATION
Caveats and Limitations
The data show the location of the death, but not the location where care was received before death (i.e. the death may have occurred in the ED but in general the care may have been provided in LTC). - No information of the preferred place of death is provided.
Comments Detailed
If there are multiple death records with different death date in each of the above administrative database, the last (i.e. most recent) death record for each unique health card number was selected. •If one health card number appears in multiple care settings, the following hierarchy based on the care intensity were used to assign death setting: acute care, Emergency, CCC, Rehabilitation facilities, LTC homes. There should only be one record per health card number. This indicator aligns with the palliative care QS overarching and the OPCN system level indicators.
Footnotes
1. Brazil K, Howell D, Bedard M, Krueger P, Heidebrecht C. Preferences for place of care and place of death among informal caregivers of the terminally ill. Palliat Medicine. 2005 Sep 1;19(6):492-499. 2. Jayaraman J, Joseph KS. Determinants of place of death: a population-based retrospective cohort study. BMC Palliat Care. 2013 May 1;12(1):1. 3. Health Quality Ontario. Team-based models for end-of-life care: an evidence-based analysis. Ont Health Technol Assess Ser [Internet]. 2014 December;14(20):1–49. Available from: http://www.hqontario.ca/evidence/publicationsand-ohtac-recommendations/ontario-health-technology-assessment-series/eol-team-based-models
 
TAGS
Sector
Acute Care/Hospital, Long Term Care, Primary Care
Type
Outcome
Topic
End-of-life / Palliative
Dimension
Effective, Patient-centred
Source
Continuing Care Reporting System (CCRS), Discharge Abstract Database (DAD), 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 15:32:00