Objectives To develop and describe the performance of two modified relational continuity of care indices for adults with organ failure nearing the end of life, addressing limitations of existing indices that penalise multispecialty physician care. Setting Linked routinely collected health administrative databases in Ontario, Canada.
Participants Adults aged ≥19 years who died between 1 January 2018 and 31 December 2022, with kidney failure on dialysis, advanced chronic obstructive pulmonary disease and/or heart failure. Primary and secondary outcome measures We adapted the Usual Provider of Care (UPC) and Bice-Boxerman Continuity of Care (BB) indices to avoid penalising multispecialty physician care, resulting in the UPC-Team and BB-Team indices.
Indices were calculated for the last 2 years of life (truncating the last month) using outpatient physician visits. Correlation coefficients were produced between the unmodified indices, the modified indices and outpatient healthcare utilisation.
Results The cohort included 199 035 individuals, with a median age of 79 years (P25, P75: 70, 86); 55.5% were male.
BMJ Open published a clinical update in Research Highlights on 31 Mar 2026.
The item focuses on Modifying continuity of care indices for adults with organ failure nearing the end of life: a retrospective population-based study in Ontario, Canada.
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