“The best places to die”

Improving end of life care requires better population level data

Although the oldest health statistics are based on death certificates, one of the weakest areas of health information is how we die. For example, in Canada 220 000 deaths occur each year. We know how many people died, and whether it was from cancer, heart disease, or other causes. But we have no idea how many of these people died in pain, hooked up to life support they didn't want, or alone. In the absence of systematic information and monitoring of end of life care and comparisons across health regions (or health care organisations) there is no possibility of learning what is possible (those regions with the highest ratings), nor of tracking whether improvements are occurring.

Twenty years ago, the challenge was to engage healthcare workers in the care of the dying. Ten years ago, the challenge was to engage healthcare organisations in quality improvement efforts on end of life care. Today, the challenge is to develop systematic and comprehensive information on the quality of end of life care at the population level.

Canada, like many countries, has a well developed health information structure—organisations such as Statistics Canada and the …