Care utilization patterns among patients dying with advanced chronic obstructive pulmonary disease
Bibliographic record
Abstract
BACKGROUND Patients with advanced chronic obstructive pulmonary disease (ACOPD) may see different medical specialists in the last year of life.OBJECTIVE The objective of this study was to describe outpatient care patterns during the last year of life for patients with ACOPD and how this relates to acute care visitation and the location of death.METHODS A retrospective cohort study of patients with ACOPD who died between 2017 and 2019 in Ontario, Canada, using linked health administrative data was conducted. Patients were classified into mutually exclusive groups based on physician care patterns to identify trends in inpatient utilization.RESULTS Patients (N = 34,837) median age at death was 78 years, 53% were male, and 84% resided in urban regions. Five outpatient encounter patterns emerged: (i) primary care, palliative care and relevant specialists to ACOPD (41%); (ii) primary care and relevant specialists (36%); (iii) primary care only led (15%); (iv) palliative care and relevant specialists (7%); and v) no outpatient encounters. All groups had a high proportion of outpatient encounters with primary care or palliative care specialists as well as high rates of hospitalizations and emergency department visits among all patients.CONCLUSIONS Patients with ACOPD predominantly receive primary care in their last year of life. Acute care utilization also varied between those receiving palliative care versus none, with higher rates being reported by patients that had no palliative care involvement. Future research should explore associations between the continuity of care among these different healthcare professionals in relation to end of life outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".