{
  "abstract": "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.Design Population-based retrospective study.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. The median modified continuity scores were higher than the unmodified scores (UPC=0.44 (0.32, 0.61), UPC-Team=0.79 (0.67, 0.89); BB=0.24 (0.15, 0.40), BB-Team=0.75 (0.52, 0.95)). The modified indices shared weaker correlations with outpatient healthcare use (ie, number of visits or specialists involved), compared with the unmodified indices.Conclusions The UPC-Team and BB-Team indices do not penalise patients for receiving multispecialty physician care, compared with the unmodified UPC and BB indices. The modified indices demonstrated more consistency in measuring continuity across patients with varying degrees of medical complexity and less correlation with outpatient healthcare use. Use of these indices is suggested to capture different aspects of relational continuity in the context of multispecialty care nearing the end of life.",
  "authors": [
    {
      "affiliations": [
        "Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada",
        "Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Shuaib Hafid"
    },
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada",
        "ICES McMaster, Hamilton, Ontario, Canada"
      ],
      "name": "Aaron Jones"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada",
        "Bruyère Health Research Institute, Ottawa, Ontario, Canada",
        "Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Sarina Isenberg"
    },
    {
      "affiliations": [
        "ICES McMaster, Hamilton, Ontario, Canada"
      ],
      "name": "Anastasia Gayowsky"
    },
    {
      "affiliations": [
        "Bruyère Health Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Aria Wills"
    },
    {
      "affiliations": [
        "Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada",
        "Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Aleisha Fernandes"
    },
    {
      "affiliations": [
        "Temmy Latner Center for Palliative Care, Department of Medicine, Sinai Health, University of Toronto, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada",
        "ICES Central, Toronto, Ontario, Canada"
      ],
      "name": "Kieran Quinn"
    },
    {
      "affiliations": [
        "Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Erin Gallagher"
    },
    {
      "affiliations": [
        "Bruyère Health Research Institute, Ottawa, Ontario, Canada",
        "Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada"
      ],
      "name": "Amy T Hsu"
    },
    {
      "affiliations": [
        "Bruyère Health Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Colleen Webber"
    },
    {
      "affiliations": [
        "Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Peter Tanuseputro"
    },
    {
      "affiliations": [
        "Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Michelle Howard"
    }
  ],
  "title": "Modifying continuity of care indices for adults with organ failure nearing the end of life: a retrospective population-based study in Ontario, Canada",
  "uid": "718f4f50-5743-54c7-8acc-78cb69995e34"
}