Intensive Care Unit (ICU) Use in the Last 2 Weeks of Life Methodology

Intensive Care Unit (ICU) Use in the Last 2 Weeks of Life Methodology
Short description of Indicator	Percentage of decedents in each malignant hematology (MH) sub-group (acute lymphoblastic leukemia [ALL], acute myeloid leukemia [AML], diffuse large B-cell lymphoma [DLBCL], multiple myeloma [MM]) who were admitted to the intensive care unit in the last 2 weeks of life.
Rationale for measurement	The last 2 weeks of life is a period of a high health care utilization for many decedents (e.g., emergency department visits, hospitalizations, intensive care unit admissions). Some of these patients would be appropriately treated aggressively if potential curative therapy is available. However, for some patients who are designated end of life or palliative prior to death, the intensive care unit may not be the best setting for managing their end-of-life care. Tracking intensive care unit use may help to identify changes in patterns of care for these end-of-life patients.
Evidence/references for rationale	Literature to support this indicator: Ho TH, Barbera L, Saskin R et al. (2014). Trends in aggressiveness of EOL cancer care in the universal health care system of Ontario, Canada. JCO vol 29no. 12 1587-91 Wang, R., Zeidan, A. M., Halene, S., Xu, X., Davidoff, A. J., Huntington, S. F., ... & Ma, X. (2017). Health care use by older adults with acute myeloid leukemia at the end of life. Journal of Clinical Oncology, 35(30), 3417. El‐Jawahri, A. R., Abel, G. A., Steensma, D. P., LeBlanc, T. W., Fathi, A. T., Graubert, T. A., ... & Attar, E. C. (2015). Health care utilization and end‐of‐life care for older patients with acute myeloid leukemia. Cancer, 121(16), 2840-2848. Busemann, C., Jülich, A., Buchhold, B., Schmidt, V., Schneidewind, L., Pink, D., ... & Krüger, W. H. (2017). Clinical course and end-of-life care in patients who have died after allogeneic stem cell transplantation. Journal of Cancer Research and Clinical Oncology, 143(10), 2067-2076.
Calculations for the indicator	Decedents with at least 1 intensive care unit admission in the last 14 days of life / Number of decedents with the specific disease = Percentage of decedents in each malignant hematology sub-group admitted to the intensive care unit in the last 2 weeks of life. For calendar years 2014 to 2018 (deaths) By type of cancer – acute myeloid leukemia, acute lymphoblastic leukemia, diffuse large B-cell lymphoma, multiple myeloma Analysis: Cohort: the Registered Persons Database (RPDB) and Ontario Cancer Registry (OCR) databases were used to identify decedents in calendar years 2014 to 2018, and the OCR was used to identify those who were diagnosed with each disease sub-group Cases were excluded if: 1) the patient did not have a valid health insurance number; or 2) the patient was younger than 18 years of age. Inclusion in the numerator was determined by examining acute discharges using the Discharge Abstract Database (DAD) in the last 2 weeks of life, and identifying intensive care unit admissions.
Standardized Rate Calculation	N/A
Unit	N/A
Data sources	Ontario Cancer Registry, Ontario Health (Cancer Care Ontario) Registered Persons Data Base, Ministry of Health Discharge Abstract Database, Canadian Institute for Health Information
Time Frame	2014 to 2018
Geographic Scale	Provincial
Denominator description	All decedents who were diagnosed with the malignant hematology disease sub-group
Numerator description	Decedents who were admitted to the intensive care unit in the last 14 days of life
Considerations	N/A
Data availability & limitations	Inclusion in the decedent cohort is not limited to those whose cause of death is the cancer in question. As a result, some deaths, and intensive care unit use in the last 2 weeks of life, may be caused by illness or injury not related to malignant hematology cancers. This analysis does not include Ontario cancer patients who died outside of Ontario, as they would not be identified in the administrative data in Ontario.