Table 2.

Description and calculation of quality indicators

Quality indicator	Description and calculation
1. Interval between last chemotherapy and death	Short interval may indicate poor quality care. Calculations: No. of cases receiving chemotherapy in last 14 days divided by all cases receiving chemotherapy in the last six months Days between the last chemotherapy and death averaged across all cases receiving chemotherapy in the last six months No. of cases receiving chemotherapy in last six months divided by entire cohort No. of cases receiving chemotherapy in last 14 days divided by entire cohort
2. Site of death	Death in hospital rather than at home may indicate poor quality care. Calculation: No. of cases dying in hospital divided by all cases in cohort
3. Frequency of emergency room (ER) visits	High number of emergency room visits near death may indicate poor quality care. Calculations: No. of cases with more than 1 ER visit in the last 30 days divided by entire cohort No. of ER visits in the last 30 days averaged across entire cohort Sum of ER visits across entire cohort divided by the sum of available days (ie, days out of hospital) across entire cohort
4.1 Hospital days near the end of life (includes any inpatient days)	Hospital stays in the terminal period of cancer may indicate poor quality care. Calculations: No. of cases with more than one hospital admission in the last 30 days divided by entire cohort No. of cases with more than 14 days in the hospital in the last 30 days divided by entire cohort Inpatient days in the last 30 days averaged across entire cohort Hospital admissions in the last 30 days averaged across entire cohort
4.2 Hospital days near the end of life (includes Intensive Care Unit (ICU) days only)	Hospital stays in the terminal period of cancer may indicate poor quality care. Calculations: No. of cases with one or more ICU admissions in the last 30 days divided by entire cohort
5. Continuity of care provided by General Practitioners (GPs) and non-GPs	Co-ordination of care by one provider and co-ordination of records may indicate good quality care. Calculations: Modified Modified Continuity Index (MMCI)45=1−(No. of ambulatory providers/[No. of ambulatory visits+/0.1])1(1/[No. of ambulatory visits+/0.1]) MMCI for GPs only – for those with > =3 GP visits MMCI for non-GPs only – for those with > =3 non-GP visits GP visits in last six months averaged across all cases with at least three GP visits Total number of GPs in last six months averaged across all cases with at least three GP visits Non-GP visits in last six months averaged across all cases with at least three non-GP visits Total number of non-GPs in last six months averaged across all cases with at least three non-GP visits
6. Time and location of care	The ideal is assumed to be clinician visits that are more frequent as death approaches. Calculation: sum of home and office visits for the entire cohort in last two weeks divided by the sum of home and office visits for the entire cohort in last six months
7. Adverse events	High proportion of adverse events may indicate poor control of symptoms and poor quality care. Examples may include falls, avoidable infections, bedsores or injuries. Calculation: number of cases who experienced a bedsore, infection, fall, or injury in the last six months divided by the entire cohort
8. Enrollment in palliative care near death	A high proportion may indicate poor quality care. Palliative care should be accessible to all patients and families with a cancer diagnosis, in a timely manner, throughout the entire duration of their disease. Calculation: No. of cases enrolled in palliative care within three days prior to death divided by all cases enrolled in palliative care
9. Access to palliative care	Palliative care will be accessible to all patients and families with a cancer diagnosis, in a timely manner, throughout the entire duration of their disease. A high proportion may indicate good quality care. Calculation: No. of cases enrolled in palliative care divided by all cases
10. Radiotherapy for uncontrolled bone pain for bony metastases	Providing patients with radiotherapy for bony metastases improves pain management and improves quality of life. A high proportion may indicate good quality care. Calculation: No. of cases who received palliative radiation to the bones divided by the entire cohort (palliative is defined as having an intent code listed as palliative or a dose level less than or equal to 3000 cGy)
11. Potent antiemetic for emetogenic chemotherapy	Potent anti-emetic therapy for highly emetogenic chemotherapy treatments greatly controls nausea and vomiting. A high proportion may indicate good quality care. Calculation: No. of cases 65 years of age and older who had a prescription for a potent antiemetic divided by all cases 65 years of age and older
12. Multidisciplinary care	Multidisciplinary care is considered an element of quality cancer care as it provides patients with access to practitioners with different perspectives and skill sets in order to achieve holistic care. Examples may include nursing services, social work, specialised medical services. A high proportion may indicate poor quality care. Calculations: Sum of GP visits for the entire cohort divided by the sum of physician visits for the entire cohort Sum of non-GP visits for the entire cohort divided by the sum of physician visits for the entire cohort
13. Access to care	Fair and equitable access to care for patient and family, regardless of financial considerations, indicates good quality care. A high proportion may indicate poor quality care. Calculation: No. of cases living in a rural area divided by entire cohort
14. Interval between new chemotherapy and death	Short interval between new chemotherapy regimen and death may indicate poor quality care. Calculation: No. of cases starting a new chemotherapy regimen in the last 30 days divided by all cases