ArticleCMAJ open
Trends in site of death and health care utilization at the end of life: a population-based cohort study.
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In one paragraph
Article in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers.
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33citing papers in PubMed
–field-weighted citation impact
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed.
- Sex differences in the associations of accelerometer-determined physical activity with physical and cognitive function in older adults living in long-term care.Frontiers in public health · 2024Trial
- Trends and factors associated with hospice care utilization and place of death in the United States between 2002 and 2020: a retrospective data analysis based on the health and retirement study.BMC palliative care · 2026Article
- Palliative care, socioeconomic position, and end-of-life cancer quality outcomes: a mediation analysis.EClinicalMedicine · 2026Article
- End-of-life healthcare utilization and costs according to cause of death: a retrospective study.BMC geriatrics · 2025Article
- Palliative Care With Tracheostomy or Gastrostomy Tube Use and End-of-Life Quality and Costs Among Patients With Head and Neck Cancer.JAMA otolaryngology-- head & neck surgery · 2025Article
- Clinical characteristics and outcomes of critically ill adult patients admitted with traumatic brain injury: a cohort study.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2025Article
- The power of partnership: Strategies for pan-Canadian spread and scale of paramedics providing palliative care.Healthcare management forum · 2025Article
- Receipt of specialized palliative care and health care utilization at the end of life in hematological cancer patients - the Stockholm experience.Acta oncologica (Stockholm, Sweden) · 2025Observational
- Healthcare trajectories of aging individuals during their last year of life: application of process mining methods to administrative health databases.BMC medical informatics and decision making · 2025Article
- Mortality in Innu communities in Labrador, 1993-2018: a cross-sectional study of causes and location of death.International journal of circumpolar health · 2024Article
- Article
- Study protocol for the development and validation of a clinical prediction tool to estimate the risk of 1-year mortality among hospitalized patients with dementia.Diagnostic and prognostic research · 2024Article
- Socioeconomic Status, Palliative Care, and Death at Home Among Patients With Cancer Before and During COVID-19.JAMA network open · 2024Article
- The association of medical, social, and normative factors with the implementation of end-of-life care practices.Israel journal of health policy research · 2024Article
- 'Confidence and fulfillment': a qualitative descriptive study exploring the impact of palliative care training for long-term care physicians and nurses.Palliative care and social practice · 2024Article
- Effectiveness of Palliative Care before Death in Reducing Emergency Care Utilization for Patients with Terminal Cancer and Trends in the Utilization of Palliative Care from 2005-2018.Healthcare (Basel, Switzerland) · 2023Article
- Article
- Healthcare Resources Utilization throughout the Last Year of Life after Acute Myocardial Infarction.Journal of clinical medicine · 2023Article
- Beyond the clinical context: the process of losing oneself living with Huntington's disease.Orphanet journal of rare diseases · 2022Article
- Inappropriate end-of-life cancer care in a generalist and specialist palliative care model: a nationwide retrospective population-based observational study.BMJ supportive & palliative care · 2022Observational
Corrections and comments
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Authors and funding
20 authors.
Andrea D HillDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC Andrea.Hill@sunnybrook.ca.
Therese A StukelDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Longdi FuDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Damon C ScalesDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Andreas LaupacisDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Gordon D RubenfeldDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Hannah WunschDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
James DownarDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Kenneth RockwoodDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Daren K HeylandDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Samir K SinhaDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Camilla ZimmermannDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Sonal GandhiDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Jeff MyersDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Heather J RossDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Jean F KozakDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Scott BerryDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Shelly P DevDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Ignazio La DelfaDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Robert A FowlerDepartments of Critical Care Medicine (Hill, Scales, Rubenfeld, Wunsch, Dev, Fowler) and of Medicine (Gandhi, Berry), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Hill); ICES (Stukel, Fu, Scales); Institute of Health Policy, Management and Evaluation (Stukel, Fowler), Interdepartmental Division of Critical Care (Scales, Rubenfeld, Wunsch, Dev, Fowler), Faculty of Medicine (Laupacis), Department of Anesthesia (Wunsch), Department of Medicine (Sinha, Gandhi, La Delfa), Division of Palliative Medicine, Department of Medicine (Zimmermann), and Division of Palliative Care, Department of Family Medicine, Faculty of Medicine (Myers), University of Toronto; Li Ka Shing Knowledge Institute (Laupacis) and Department of Palliative Care (La Delfa), St. Michael's Hospital, Toronto, Ont.; Departments of Medicine and Critical Care (Downar), Division of Palliative Care, University of Ottawa, Ottawa, Ont.; Divisions of Geriatric Medicine and Neurology (Rockwood), Department of Medicine, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Heyland), Queen's University, Kingston Ont.; Department of Medicine (Sinha) and Division of Palliative Care (Myers), Sinai Health System; Department of Medicine (Sinha), Division of Palliative Care, Department of Supportive Care (Zimmermann), and Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre (Ross), University Health Network, Toronto, Ont.; School of Population and Public Health (Kozak), University of British Columbia; Department of Family and Community Medicine (Kozak), Providence Health Care, Vancouver, BC.
Funding
UNDERSTANDING AND IMPROVING EPISODE-BASED HOSPITAL CAREP01AG019783 · NIA · DARTMOUTH COLLEGE · PI Leila S. Agha · 2001 to 2026
$52.9MNIA NIH HHS P01 AG019783
Abstract
backgroundHigh rates of health care utilization at the end of life may be a marker of care that does not align with patient-stated preferences. We sought to describe trends in end-of-life care and factors associated with dying in hospital.
methodsWe conducted a population-level retrospective cohort study of adult decedents in Ontario between Apr. 1, 2004, and Mar. 31, 2015, using linked administrative data sets, including the Office of the Registrar General for Deaths database, the hospital Discharge Abstract Database, the National Ambulatory Care Reporting System and physicians' billing claims (Ontario Health Insurance Plan). The primary outcome was place of death. To determine health care utilization and health care costs during the 6 months before death, we also identified admissions to hospital and to the intensive care unit, emergency department visits, and receipt of mechanical ventilation and palliative care.
resultsIn the last 6 months of life, 77.3% of 962 462 decedents presented to an emergency department, 68.4% were admitted to hospital, 19.4% were admitted to an intensive care unit, and 13.9% received mechanical ventilation. Forty-five percent of all deaths occurred in hospital, a proportion that declined marginally over time, whereas receipt of palliative care increased during terminal hospital admissions (from 14.0% in fiscal year 2004/05 to 29.3% in 2014/15,
interpretationHealth care utilization in the last 6 months of life was substantial and did not decrease over time. It is possible that increased capacity for palliative, hospice and home care at the end of life may help to better align health system resources with the preferences of most patients, a topic that should be explored in future studies.
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