• Jessica Ma, Jessica Beliveau, Wendy Snider, Weston Jordan, and David Casarett.
• Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health System, Durham, North Carolina, USA. Electronic address: Jessica.ma@duke.edu.
• J Pain Symptom Manage. 2021 Sep 1; 62 (3): e200-e205.

ContextAlthough health systems need to track utilization and mortality, it can be difficult to obtain reliable information on patients who die outside of the health system. This leads to missing data and introduces the potential for bias.ObjectivesTo evaluate the linkage of patient death data sources with a tertiary health system electronic health record (EHR) to increase the accuracy of health system end-of-life healthcare utilization data in the last month and six months of life.MethodsThe federal Death Master File (DMF) and North Carolina Department of Health and Human Services (NC DHHS) decedent files from 2017 and 2018 were linked to a health system EHR. Descriptive statistics and chi-square tests were utilized to define impact of additional data sources with demographic data and end-of-life utilization.ResultsA total of 65,935 patient deaths were identified through our multi-step data integration process. Approximately a quarter of patients (28.3%) had at least one inpatient or outpatient health system encounter in the last six months of life. Of these, patient deaths identified only in the NC DHHS file were less likely (OR 0.45 [95%CI 0.39-0.52]) to be hospitalized in the last month of life.ConclusionWe describe a method to supplement EHR data with decedent information across data sources. While additional decedent data improves the accuracy of death data in the health system, patient healthcare utilization is biased towards those who use the health system at the end of life.Published by Elsevier Inc.

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