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Emergency Department Visits in the Last 30 Days of Life Methodology

Emergency Department Visits in the Last 30 Days of Life Methodology
Short description of Indicator Percentage of decedents in each malignant hematology sub-group (acute lymphoblastic leukemia [ALL], acute myeloid leukemia [AML], diffuse large B-cell lymphoma [DLBCL], multiple myeloma [MM]) who visited the emergency department in the last 30 days of life.
Rationale for measurement The last 30 days of life is a period of high health care utilization for many decedents (e.g., emergency department visits, hospitalizations, intensive care unit admission). In the palliative setting, this indicator tracks the ongoing effectiveness of palliative services that can mitigate hospitalization and emergency department visits. In this context, it is expected that the malignant hematology sub-populations will need to use the emergency department more than cancer decedents overall, and that some of that use is appropriate.
Evidence/references for rationale Literature to support this indicator:
  • 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 emergency department visit in the last 30 days of life / Number of decedents with the specific disease = Percentage of decedents in each malignant hematology sub-group admitted to the emergency department in the last 30 days of life
  • For calendar years 2014 to 2018 (deaths)
  • By type of cancer – acute myeloid leukemia, acute lymphoblastic leukemia, diffuse lymphoblastic B-cell leukemia, 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 searching the National Ambulatory Care Reporting System (NACRS) in the last 30 days of life, and identifying emergency department visits.
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
  • National Ambulatory Care Reporting System, 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 visited the emergency department in the last 30 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 emergency department visits in the last 30 days 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.