Measuring geographic proximity and continuity with family medicine at
end-of-life: Protocol for a population-level retrospective cohort study using
Canadian Health Administrative Data
#MMPMID41343551
Hafid S
; Mbuagbaw L
; Newbold B
; Costa A
; Gayowsky A
; Gozdyra P
; Jones A
; Isenberg S
; Gallagher E
; Howard M
PLoS One
2025[]; 20
(12
): e0336790
PMID41343551
show ga
BACKGROUND: Family physicians play an important role in coordinating care for
medically complex patients, especially during the end-of-life (EOL) period. While
continuity of care (COC) is a routinely measured care quality indicator, the
influence of geographic proximity to family physicians on EOL COC has not been
studied in the Canadian context. Existing research has focused on rurality
indicators instead of individual-level proximity measures. OBJECTIVES: This study
objectives are to: (1) measure the association between patients' geographic
proximity to their family physician and COC during the patients' last year of
life; and (2) measure the association between geographic proximity and the number
of days spent in the community and palliative homecare services referral in the
last year of life, and place of death. METHODS: We will conduct a
population-level retrospective cohort study using linked health administrative
data from ICES in Ontario, Canada, of adults who died between January 1, 2021,
and December 31, 2024. Geographic proximity to the rostered family physician will
be calculated in the shortest travel distance and time from the patient's
residence to the physicians primary practice location, considering road, transit,
and walking infrastructure. COC will be measured using three indices: Usual
Provider of Care, Modified Bice-Boxerman, and Relative Variance indices, based on
outpatient visits in the last year of life. EOL outcomes will include days spent
in the community, referral to palliative home care, and place of death.
Multivariate regression will measure associations between proximity and outcomes,
adjusting for relevant patient-level characteristics. EXPECTED OUTCOMES: We
hypothesize that patients living closer to their family physician will experience
higher COC and improved healthcare outcomes at the end of life. Findings have the
potential to inform health policy and planning aimed at improving equitable
geographic access to family medicine during the late stages of life.
|*Continuity of Patient Care/statistics & numerical data
[MESH]
|*Family Practice
[MESH]
|*Health Services Accessibility/statistics & numerical data
[MESH]
|*Terminal Care/statistics & numerical data
[MESH]
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