Measuring the relationship between outpatient family physician visit regularity and acute care utilization during the end of life: a population-level retrospective cohort study

Background — Family physicians (FP) are critical in providing outpatient end-of-life (EOL) care, yet most continuity measures do not consider temporal changes in visits. The relative variance index (RVI), which measures visit interval variation, has not been applied to the EOL context.

Aim — To measure the association between outpatient FP visit regularity & acute care use in the last month of life.

Design — Retrospective cohort study using linked population-level health administrative data. FP visit regularity was measured using the RVI, calculated from outpatient visits during the last two years of life (excluding the last month). Outcomes included hospitalizations, emergency department (ED) visits in the last month of life & acute care setting deaths.

Setting — Adults with cardiorespiratory conditions who died in Ontario, Canada, between 2017 & 2019.

Results — Patients’ (N = 151 030) median age at 2-years before death was 80, 55% were male, & had a median of 9 FP outpatient visits in the last two years of life. Higher FP RVI scores were associated with increased hospitalizations (IRR [95% CI]: 1.07 [1.05,1.10]), ED visits (1.06 [1.03, 1.08]) & acute care deaths (OR [95% CI]: 1.30 [1.26, 1.35]). Sensitivity analyses identified that RVI scores varied across different look-back periods, while sensitivity model performances remained stable when adjusting for specialist visit regularity.

Conclusions — Higher outpatient FP visit regularity was associated with increased EOL acute care use, despite low visit regularity during the last two years of life. However, the RVI’s sensitivity to observation period lengths limits its utility as an EOL care-quality indicator.