Benchmarks for end of life care in a community oncology practice

Abstract

8105 Background: There are efforts on many fronts to measure the quality of oncology care, particularly at the end of life. Yet benchmarks for community oncology practices are lacking. We undertook this study to: 1) assess the obstacles to obtaining data on end of life care and 2) establish benchmarks for quality improvement. Methods: Deceased patients were identified either through death certificates and obituaries or through a cancer registry. The charts were abstracted for the criteria that follow results. Results: 202 patients were identified in a community practice with two different sites served by six medical oncologists and 2 gynecologic oncologists over a period of two years. Of these 202 patients, 143 were deemed hospice appropriate (projected life span of 6 months or less, remained in the community, continued follow-up by our physicians). 105 of 143 were enrolled in hospice (73.4% of hospice appropriate or 52% of total). Of those enrolled mean length of enrollment was 28.6 days, median 21 days; average number of hospital days in the last 30 days was 2.6 (276/105) and the percent that had a new regimen of chemotherapy in the last 30 days was 1.9 (2/105). 51.4 (54/105) percent died at home, 26.7 (28/105) died in a freestanding hospice inpatient facility and 0.95 (1/105) died in the hospital. For 21% the place of death could not be determined from the record. In 22.9% (24/105) hospice enrollment occurred in the last 7 days of life. Conclusions: The constituents for good end of life care as identified by SUPPORT and the Promoting Excellence projects can be achieved in a community oncology practice. The overall hospice enrollment, resource utilization and achieved choice of place of death compare favorably with published data. The chief concern is the rate of late enrollments. Characteristics of the practice contributing to these results will be discussed, as will plans for quality improvement. No significant financial relationships to disclose.