Unwarranted variations in end-of-life care and the impact of using an electronic coordination system.

This study looks at the variations in end-of-life care in North-East Essex (eastern England) combining hospital records, official death records and the local electronic end-of-life coordination tool. These differences included dying in hospital (versus a general wish to die in the usual place of residence), and inequity in care provision: the place of death varying according to the cause of death (even for highly predictable conditions); and deprivation being associated with a greater likelihood of dying in hospital. There was a positive correlation between the use of an electronic end-of-life coordination system and dying in the preferred place of care. The results suggest two actions for policy makers. First, look at variations in end-of-life care so that areas of need can be identified. Second, use of an electronic end-of-life coordination tool is correlated with a reduction in unwarranted variation in the place of death.

Building on sand: digital technologies for care coordination and advance care planning.

Approaches using digital technologies to support advance care planning (ACP) and care coordination are being used in palliative and end of life care. While providing opportunities to facilitate increases in the completeness, sharing and availability of care plans, the evidence base underpinning their use remains limited. We outline an approach that continues to be developed in England; Electronic Palliative Care Coordination Systems (EPaCCS). Stages governing their optimal use are outlined alongside unanswered questions with relevance across technology-mediated approaches to ACP. Research has a critical role in determining if technology-mediated approaches to ACP, such as EPaCCS, could be useful tools to support the delivery of care for patients with chronic and progressive illnesses.