Developing a physician continuity of care index for end-of-life care

The Continuity of Care (CoC) at the End-of-Life study, led by Michelle Howard, aims to develop a physician CoC index specific to the end-of-life context. This study employs a mixed-methods approach, combining quantitative analysis of provincial health administrative data at ICES with qualitative interviews of bereaved caregivers whose loved ones received end-of-life care.

The research team conducted three retrospective cohort studies to analyze outpatient care patterns in patients with kidney failure on dialysis, advanced COPD, and heart failure, who died in Ontario from 2017 to 2019. The studies revealed that family physicians are consistently involved throughout the last year of life, alongside multiple physician specialties. These findings highlight the need for CoC indices to account for the appropriate involvement of various physician specialties at the end of life.

Therefore, the investigators are adapting the Usual Provider of Care index to reflect team-based care and will then measure the association between this adapted index and end-of-life healthcare outcomes. Both quantitative and qualitative findings will inform the development of a theory of CoC specific to this life stage.