Days Spent at Home in the Last 6 Months of Life. a Potential Patient-Determined Quality Indicator for Patients with Hematologic Malignancies at the End of Life
Notice bibliographique
Résumé
Abstract Despite advances in the management of patients with hematologic malignancies, a significant proportion of patients will still die of their disease. Current quality indicators at the end of life (EOL) focus on whether patients receive aggressive interventions, including chemotherapy in the last days of life. However, frail patients and caregivers themselves have recently highlighted that “time spent at home” represents the most important measure of EOL quality care (Groff et al., NEJM 2016). This potential patient-determined quality indicator has not been previously studied in patients with hematologic malignancies. We used population-based health system administrative databases from Ontario, Canada. We identified a cohort of all adult patients who died of a hematologic malignancy from January 2005 to December 2013 within the Ontario Cancer Registry. The primary outcome of “days at home” in the last 6 months of life was defined as: 180 days minus the number of days in an acute care facility (inpatient, emergency department, and same day surgery stays), an inpatient rehabilitation facility, skilled nursing facility, or chronic care facility. We further identified patient variables (including comorbidities identified by a mortality risk score by Austin and van Walraven, Med Care 2011) and system level variables (including palliative care consultation prior to the last 6 months of life) that predicted for number of days at home and identified trends over time. We used a logistic regression model to identify relevant predictors of time spent at home beyond the median. During the relevant time-period, 6792 patients with hematologic malignancies died in Ontario. Median age was 72 (IQR 62-80) at the time of cancer death and 58% of patients were male. Median comorbidity score, measured by the mortality risk score, was moderate-to-high at 27 (IQR 20-34), 15% of patients were rural-based, and 27% had received palliative care consultation prior to the last 6 months of life. The median number of days at home in the last 6 months of life was 166 days; 81% of patients spent more than 120 days at home over the last 6 months of life. Increased age (per five year increase OR 1.14; CI 1.12-1.17; p In a large population of patients who die from hematologic malignancies, >80% of patients spend >120 days at home in the last 6 months of life. Certain demographic features of patients more likely to die at home suggest an important role for access to caregiver support (i.e. spousal/family support). Importantly, earlier access to palliative care may increase the likelihood that patients can die at home, representing a modifiable/actionable factor for physicians to consider to improve the quality of care in patients who are nearing the end of life. Disclosures No relevant conflicts of interest to declare.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».