Feasibility of using death certificates for studying place of death in Latin America

[ABSTRACT]. Objective. This paper assesses the availability and quality of death certificate data in Latin America and the feasibility of using these data to study place of death and associated factors. Methods. In this comparative study, we collected examples of current official death certificates and digital data files containing information about all deaths that occurred during 1 year in 19 Latin American countries. Data were collected from June 2019 to May 2020. The records for place of death and associated variables were studied. The criteria for data quality were completeness, number of ill-defined causes of death and timeliness. Results. All 19 countries provided copies of current official death certificates and 18 of these registered the place of death. Distinguishing among hospital or other health care institution, home and other was possible for all countries. Digital data files with death certificate data were available from 12 countries and 1 region. Three countries had data considered to be of high quality and seven had data considered to be of medium quality. Categories for place of death and most of the predetermined factors possibly associated with place of death were included in the data files. Conclusions. The quality of data sets was rated medium to high in 10 countries. Hence, death certificate data make it feasible to conduct an international comparative study on place of death and the associated factors in Latin America.

[RESUMEN]. Objetivo. En este artículo se evalúa la disponibilidad y la calidad de los datos del certificado de defunción en América Latina y la factibilidad de emplear estos datos para estudiar el lugar de defunción y factores asociados. Métodos. En este estudio comparativo, se recogieron ejemplos de certificados oficiales de defunción actuales y archivos digitales de datos que contenían información acerca de todas las defunciones que ocurrieron durante un año en 19 países latinoamericanos. Se recopilaron datos desde junio del 2019 hasta mayo del 2020. Se estudiaron los registros del lugar de la muerte y las variables asociadas. Los criterios para determinar la calidad de los datos fueron la exhaustividad, el número de causas de muerte mal definidas y la presentación oportuna de la información. Resultados. Los 19 países proporcionaron copias de los certificados oficiales de defunción actuales; en 18 de estos se registraba el lugar de la muerte. En todos los países fue posible distinguir entre hospital u otra institución de atención de salud, el hogar y otros. Se obtuvieron los archivos de datos digitales con los datos del certificado de defunción de 12 países y una región. Tres países tenían datos considerados de buena calidad y siete tenían datos considerados de calidad media. En los archivos de datos se incluyeron categorías para lugar de defunción y la mayoría de los factores predeterminados posiblemente asociados con el lugar de defunción. Conclusiones. La calidad de los conjuntos de datos se calificó de media a buena en 10 países. En consecuencia, es factible realizar un estudio internacional comparativo sobre el lugar de defunción y los factores asociados en América Latina con los datos del certificado de defunción.

[RESUMO]. Objetivo. Este estudo avalia a disponibilidade e a qualidade dos dados das declarações de óbito na América Latina e a viabilidade de usar esses dados para estudar o local do óbito e fatores associados. Métodos. Neste estudo comparativo, coletamos exemplos de declarações de óbito oficiais atuais e arquivos de dados digitais contendo informações sobre todos os óbitos que ocorreram durante 1 ano em 19 países latinoamericanos. Os dados foram coletados no período de junho de 2019 a maio de 2020. Foram estudados os registros do local do óbito e variáveis associadas. Os critérios de qualidade dos dados foram preenchimento completo, número de causas mal definidas de morte e oportunidade. Resultados. Todos os 19 países forneceram cópias das declarações de óbito oficiais atuais, e 18 deles registraram o local do óbito . Foi possível distinguir em todos os países entre hospital ou outra instituição de saúde, lar ou outro local. Arquivos de dados digitais com os dados das declarações de óbito foram disponibilizados por 12 países e 1 região. Três países tiveram dados considerados de alta qualidade, e sete tiveram dados considerados de qualidade média. As categorias de local do óbito e a maioria dos fatores predeterminados possivelmente associados ao local do óbito foram incluídos nos arquivos de dados. Conclusões. A qualidade dos conjuntos de dados foi classificada como média a alta em 10 países. Portanto, os dados de declarações de óbito possibilitam a realização de um estudo comparativo internacional sobre local do óbito e fatores associados na América Latina.

Valoración de disparadores de consulta para optimizar la oportunidad de acceso a los cuidados paliativos en la UCI / Assessment of consultation triggers to optimize the opportunity to access palliative care in the ICU / Avaliação dos critérios de elegibilidade para otimizar a oportunidade de acesso aos cuidados paliativos na UTI

Resumen: Introducción: los cuidados paliativos (CP) son un marcador de calidad de asistencia en terapia intensiva; sin embargo, han sido poco evaluados en Uruguay. La detección proactiva de pacientes mediante disparadores de consultas es una estrategia que podría optimizar el acceso a los CP. Objetivos: determinar la prevalencia y las características de los disparadores de consulta de CP en pacientes críticos. Analizar la utilización de recursos en estos pacientes. Material y método: estudio de cohorte, retrospectivo, que incluyó pacientes ingresados a unidad de cuidados intensivos (UCI) entre marzo de 2016 y febrero de 2019. Los disparadores analizados fueron: a) presencia de tumor con metástasis; b) estadía en UCI 50% por encima de la media (14 días); c) >75 años con disfunción orgánica múltiple, y d) >80 años con dos o más comorbilidades graves. Resultados: se analizaron 2.850 pacientes. El 26% (734) presentó al menos un disparador de consulta con CP. El más prevalente: estadía en UCI 50% por encima de la media (18%). Estos pacientes presentaron mayor edad: 61 (43-75) vs 54 (36-65) años (p < 0,001) y mayor gravedad, SAPSIII de 60 (48-74) vs 47 (35-61) puntos (p<0,001). Requirieron más asistencia respiratoria mecánica (ARM) 87% vs 55% (p <0,001), vasopresores 48% vs 24% (p< 0,001) y hemodiálisis 8% vs 4% (p<0,001). Presentaron mayor estadía 18 (9-27) vs 4 (2-8) días, (p<0,001) y tiempo en ARM 14 (7-23) vs 3 (1- 6) días (p<0,001). Conclusiones: la cuarta parte de los pacientes en UCI activaron al menos un criterio de CP, presentaron mayor gravedad y utilizaron más sostén de soporte vital.

Summary: Introduction: palliative care (PC) constitutes a marker of the quality of intensive care assistance. However, it has not been thoroughly assessed in Uruguay. Proactive detection of patients by means of "consultation triggers" should be considered a strategy to optimize access to PC. Objetives: to determine the prevalence and characteristics of Palliative Care consultation triggers in critical patients. To analyse the use of resources in these patients. Method: retrospective cohort study of patients admitted in the ICU between March 2016 and February 2019. The following triggers were identified: a) a tumor with metastasis; length of stay at the ICU 50% over the average (14 days), c) >75 years old with multiple organic dysfunction and d) >80 years old with 2 or more severe comorbidities Results: 2.850 patients were analysed. 26% (734) presented at least one consultation trigger with PC. Length of stay at the ICU 50% over average (18%). These patients presented higher average age 61 (43-75) versus 54 (36-65) years old (p < 0.001), and increased severity, SAPSIII of 60 (48-74) compared to 47 (35-61) points (p<0.001); 87% required mechanical ventilation compared to 55% (p <0.001), vasopressors 48% compared to 24% (p< 0.001) and hemodialysis 8% compared to 4% (p<0.001). 18 presented a longer stay (9-27) compared to 4 (2-8) days, (p<0.001) and time on mechanical ventilation 14 (7-23) compared to 3 (1- 6) days (p<0.001). Conclusions: 25 percent of patients in the ICU activated at least one criterion for PC, they were in a more severe condition and used more mechanical ventilation.

Resumo: Introdução: os cuidados paliativos (CP) são um marcador de qualidade da atenção em Terapia Intensiva, porém, pouco avaliados no Uruguai. A detecção proativa de pacientes usando "gatilhos de consulta" é uma estratégia que pode otimizar o acesso aos CP. Metas: determinar a prevalência e as características dos critérios de elegibilidade de CP em pacientes críticos. Analisar o uso de recursos nesses pacientes. Materiais e métodos: estudo de coorte retrospectivo, incluindo pacientes internados na UTI entre março de 2016 e fevereiro de 2019. Os critérios analisados foram: a) presença de tumor com metástase, b) permanência na UTI 50% acima da média (14 dias), c ) >75 anos com disfunção de múltiplos órgãos e d) >80 anos com 2 ou mais comorbidades graves. Resultados: 2.850 pacientes foram analisados. 26% (734) apresentaram pelo menos 1 critério de elegibilidade para CP. O mais prevalente foi a permanecia na UTI 50% superior à média (18%). Esses pacientes tinham mais de 61 anos (43-75) vs 54 (36-65) anos (p <0,001) e condições mais graves, SAPSIII de 60 (48-74) vs 47 (35-61) pontos (p <0,001). Necessitaram mais ventilação mecânica assistida (AVM) 87% vs 55% (p <0,001), vasopressores 48% vs 24% (p <0,001) e hemodiálise 8% vs 4% (p <0,001). Tiveram uma permanência mais prolongada 18 (9-27) vs 4 (2-8) dias, (p <0,001) e tempo em AVM 14 (7-23) vs 3 (1-6) dias (p <0,001). Conclusões: um quarto dos pacientes internados na UTI ativou pelo menos um critério de elegibilidade para CP, apresentou maior gravidade e utilizou mais suporte vital.

Feasibility of using death certificates for studying place of death in Latin America

Objective: this paper assesses the availability and quality of death certificate data in Latin America and the feasibility of using these data to study place of death and associated factors. Methods: in this comparative study, we collected examples of current official death certificates and digital data files containing information about all deaths that occurred during 1 year in 19 Latin American countries. Data were collected from June 2019 to May 2020. The records for place of death and associated variables were studied. The criteria for data quality were completeness, number of ill-defined causes of death and timeliness. Results: all 19 countries provided copies of current official death certificates and 18 of these registered the place of death. Distinguishing among hospital or other health care institution, home and other was possible for all countries. Digital data files with death certificate data were available from 12 countries and 1 region. Three countries had data considered to be of high quality and seven had data considered to be of medium quality. Categories for place of death and most of the predetermined factors possibly associated with place of death were included in the data files. Conclusions: the quality of data sets was rated medium to high in 10 countries. Hence, death certificate data make it feasible to conduct an international comparative study on place of death and the associated factors in Latin America.

Technology for improving accessibility of end-of-life care: Extension for Community Healthcare Outcomes Project.

PURPOSE OF REVIEW: To describe how Project ECHO works and to analyze what has been published on Project ECHO Palliative Care (Project ECHO PC) over the last 18 months. RECENT FINDINGS: Only two articles on Project ECHO PC have been published over the last 18 months: a descriptive study of experiences in seven health centers of the United States, the United Kingdom, Uruguay and India; and a quantitative and qualitative study of the impact of the teleECHO clinic on physicians and nurses in Northern Ireland, which reports a significant boost in knowledge acquisition and self-efficacy. SUMMARY: Project ECHO is an innovative telemedicine strategy, which creates learning communities, which use a standardized methodology and benefits healthcare professionals, particularly primary care providers or practitioners based on remote or rural areas.Since 2011, Project ECHO PC has been implemented in 12 health centers in 4 different countries, with greater growth in 2017. It has facilitated a wider access to professional education, improvements in clinical practice and knowledge acquisition, the development of professional curricula and more confidence and self-efficacy among healthcare professionals. Project ECHO PC is engaged in several international initiatives to aid countries with different degrees of palliative care development.