• Cara L McDermott, Ruth A Engelberg, Cossette Woo, Li Li, Catherine Fedorenko, Scott D Ramsey, and Curtis J Randall JR Cambia Palliative Care Center of Excellence Department of Medicine, University of Washington, Seattle, Washington, USA..
• Cambia Palliative Care Center of Excellence Department of Medicine, University of Washington, Seattle, Washington, USA; Hutchinson Institute for Cancer Outcomes Research Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. Electronic address: clm2@uw.edu.
• J Pain Symptom Manage. 2019 Nov 1; 58 (5): 851-856.

ContextWorking groups have called for linkages of existing and diverse databases to improve quality measurement in palliative and end-of-life (EOL) care, but limited data are available on the challenges of using different data sources to measure such care.ObjectivesTo assess concordance of data obtained from different sources in a novel linkage of death certificates, electronic health records (EHRs), cancer registry data, and insurance claims for patients who died with cancer.MethodsWe joined a database of Washington State death certificates and EHR to a data repository of commercial health plan enrollment and claims files linked to registry records from Puget Sound Cancer Surveillance System. We assessed care in the last month including hospitalizations, intensive care unit (ICU) admissions, emergency department visits, imaging scans, radiation, and hospice, plus chemotherapy in the last 14 days. We used a Chi-squared test to compare differences between health care in EHR and claims.ResultsRecords of hospitalization, ICU use, and emergency department use were 33%, 15%, and 33% lower in EHR versus claims, respectively. Radiation, hospice, and imaging were 6%, 14%, and 28% lower, respectively, in EHR, but chemotherapy was 4% higher than that in claims. These differences were statistically different for hospice (P < 0.02), hospitalization, ICU, ER, and imaging (all P < 0.01) but not radiation (P = 0.12) or chemotherapy (P = 0.29).ConclusionWe found substantial variation between EHR and claims for EOL health-care use. Reliance on EHR will miss some health-care use, while claims will not capture the complex clinical details in EHR that can help define the quality of palliative care and EOL health-care utilization.Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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