Examining the Contemporary Use of Hospitals in Canada for Palliative Care Purposes: A Population-Based Study to Enable Policy and Program Developments.

Background: It is commonly thought that most deaths in developed countries take place in hospital. Death place is a palliative care quality indicator. Objectives: To determine the use of Canadian hospitals by patients who died in hospital during the 2019-2020 year and any additional hospital utilization occurring over their last 365 days of life. Design: An investigation of population-based (2018-2020) Canadian hospital data using SAS. Settings/Subjects: All patients admitted to hospital and discharged alive or deceased. Measurements: Describe patients who died in hospital, and any additional use of hospitals by these patients over their last year of life. Results: Ninety-one thousand six hundred forty inpatients died during 2019-2020; 4.85% of all 1.88 million hospitalized individuals and 41.82% of all deaths in Canada that year. Decedents were primarily 65+ years of age (81.16%), male (53.44%), admitted through an emergency department (80.16%), and arrived by ambulance (72.15%). The most common diagnosis was the nonspecific ICD-10 defined "factors influencing health status and contact with health services" (23.75%), followed by "circulatory diseases" (18.22%), "respiratory diseases" (15.58%), and many other less common diagnoses. The average length of final hospital stay was 16.54 days, with 89.97% having some Alternative Level of Care (ALC) or ALC days recorded, indicating another care setting was preferable. Only 5.78% had cardiopulmonary resuscitation performed during their final hospitalization. Of all 91,640 decedents, 74.33% had only one admission to hospital in their last 365 days of life, while 25.67% (more often younger than older decedents) had two to five admissions. Conclusions: This study confirms a continuing shift of death and dying out of hospital in Canada. Most deaths and end-of-life care preceding death take place outside of hospitals now. Enhanced community-based services are recommended to support optimal dying processes outside of hospitals and also help more dying people avoid hospital deaths.