Did Ontario's End-of-Life Care Strategy Reduce Acute Care Service Use?: The need to use quality indicators for improvement
Bibliographic record
Abstract
The objective of this study was to evaluate whether Ontario's End-of-Life Care Strategy, which aimed to shift care from acute settings to the home, improved performance on quality indicators for end-of-life home care patients in use of more home care services and fewer acute care services. The study cohort included patients at the end of life admitted into home care between April 1, 2005, and September 30, 2006, and who died before April 1, 2007. Based on their admission date, patients were divided into three six-month periods corresponding to the six months prior to the strategy's implementation compared with the 12 months after. Patients were excluded if they were admitted to home care more than six months prior to death. Average hours per week of nursing and personal support worker (PSW) services were measured for the last 12 weeks of life. The use of acute care services in the last month of life was measured by the proportion of patients who had an in-hospital death, had hospitalizations, visited the emergency department (ED) and spent more than 14 days in hospital. Among home care patients (n = 9,368), per-patient use of home care and acute care did not change significantly over the time periods. The pattern of average nursing and PSW hours per week used in the last 12 weeks of life did not change a year after the strategy implementation, averaging 3.8 nursing hours per week and 3.8 PSW hours per week over the study period. The proportion of in-hospital deaths remained stable at approximately 38% over the study period. Approximately 16% of patients had an ED visit and 32% had a hospitalization in the last two weeks of life across time periods. Similarly the proportion of patients who had zero, one or greater than one ED visit or hospitalization remained constant across time periods. In conclusion, one year after the strategy's implementation, individual patients' use of end-of-life home care and acute care services remained unchanged. The strategy may require more time for its impact to be fully achieved. Measuring these quality indicators across regions may help to monitor and evaluate interventions.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".