{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T04:08:22Z","timestamp":1781064502529,"version":"3.54.1"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T00:00:00Z","timestamp":1738713600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T00:00:00Z","timestamp":1738713600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Institut national d'excellence en sant\u00e9 et services sociaux"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Context<\/jats:title>\n            <jats:p>World is aging and the prevalence of chronic diseases is raising with age, increasing financial strain on organizations but also affecting patients\u2019 quality of life until death. Research on healthcare trajectories has gained importance, as it can help anticipate patients\u2019 needs and optimize service organization. In an overburdened system, it is essential to develop automated methods based on comprehensive and reliable and already available data to model and predict healthcare trajectories and future utilization. Process mining, a family of process management and data science techniques used to derive insights from the data generated by a process, can be a solid candidate to provide a useful tool to support decision-making.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>We aimed to <jats:italic>(1)<\/jats:italic> identify the healthcare baseline trajectories during the last year of life, <jats:italic>(2)<\/jats:italic> identify the differences in trajectories according to medical condition, and <jats:italic>(3)<\/jats:italic> identify adequate settings to provide a useful output.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We applied process mining techniques on a retrospective longitudinal cohort of 21,255 individuals who died between April 1, 2014, and March 31, 2018, and were at least 66 years or older at death. We used 6 different administrative health databases (emergency visit, hospitalisation, homecare, medical consultation, death register and administrative), to model individuals\u2019 healthcare trajectories during their last year of life.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Three main trajectories of healthcare utilization were highlighted: <jats:italic>(i)<\/jats:italic> mainly accommodating a long-term care center; <jats:italic>(ii)<\/jats:italic> services provided by local community centers in combination with a high proportion of medical consultations and acute care (emergency and hospital); and <jats:italic>(iii)<\/jats:italic> combination of consultations, emergency visits and hospitalization with no other management by local community centers or LTCs. Stratifying according to the cause of death highlighted that LTC accommodation was preponderant for individuals who died of physical and cognitive frailty. Conversely, services offered by local community centers were more prevalent among individuals who died of a terminal illness. This difference is potentially related to the access to and use of palliative care at the end-of-life, especially home palliative care implementation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Despite some limitations related to data and visual limitations, process mining seems to be a method that is both relevant and simple to implement. It provides a visual representation of the processes recorded in various health system databases and allows for the visualization of the different trajectories of healthcare utilization.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12911-025-02898-9","type":"journal-article","created":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T11:29:30Z","timestamp":1738754970000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Healthcare trajectories of aging individuals during their last year of life: application of process mining methods to administrative health databases"],"prefix":"10.1186","volume":"25","author":[{"given":"Delphine","family":"Bosson-Rieutort","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Langford-Avelar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliette","family":"Duc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Dalmas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,5]]},"reference":[{"key":"2898_CR1","unstructured":"OECD, Health at a OECD. 2021 [cited 2025 Jan 14]. (Health at a Glance). Available from: https:\/\/www.oecd.org\/en\/publications\/health-at-a-glance-2021_ae3016b9-en.html"},{"key":"2898_CR2","unstructured":"Statistics Canada. Population projections for Canada (2018 to 2068), provinces and territories (2018 to 2043). [Internet]. 2019 [cited 2022 Feb 25]. Available from: https:\/\/epe.lac-bac.gc.ca\/100\/201\/301\/weekly_acquisitions_list-ef\/2020\/20-41\/publications.gc.ca\/collections\/collection_2020\/statcan\/91-520-x2019001-eng.pdf"},{"issue":"7","key":"2898_CR3","doi-asserted-by":"publisher","first-page":"215","DOI":"10.24095\/hpcdp.37.7.02","volume":"37","author":"A Feely","year":"2017","unstructured":"Feely A, Lix LM, Reimer K. Estimating multimorbidity prevalence with the Canadian chronic Disease Surveillance System. Health Promotion Chronic Disease Prev Can. 2017;37(7):215\u201322.","journal-title":"Health Promotion Chronic Disease Prev Can"},{"issue":"6","key":"2898_CR4","doi-asserted-by":"publisher","first-page":"87","DOI":"10.24095\/hpcdp.35.6.01","volume":"35","author":"KC Roberts","year":"2015","unstructured":"Roberts KC, Rao DP, Bennett TL, Loukine L, Jayaraman GC. Prevalence and patterns of chronic disease multimorbidity and associated determinants in Canada. Health Promot Chronic Dis Prev Can. 2015;35(6):87\u201394.","journal-title":"Health Promot Chronic Dis Prev Can"},{"key":"2898_CR5","doi-asserted-by":"publisher","unstructured":"Sakib MN, Shooshtari S, St. John P, Menec V. The prevalence of multimorbidity and associations with lifestyle factors among middle-aged Canadians: an analysis of Canadian Longitudinal Study on Aging data. BMC Public Health [Internet]. 2019 Dec [cited 2019 May 3];19(1). Available from: https:\/\/bmcpublichealth.biomedcentral.com\/articles\/https:\/\/doi.org\/10.1186\/s12889-019-6567-x","DOI":"10.1186\/s12889-019-6567-x"},{"issue":"3","key":"2898_CR6","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1001\/jama.2015.18603","volume":"315","author":"JE Bekelman","year":"2016","unstructured":"Bekelman JE, Halpern SD, Blankart CR, Bynum JP, Cohen J, Fowler R, et al. Comparison of site of death, Health Care utilization, and Hospital expenditures for patients dying with Cancer in 7 developed countries. JAMA. 2016;315(3):272\u201383.","journal-title":"JAMA"},{"issue":"3","key":"2898_CR7","doi-asserted-by":"publisher","first-page":"127","DOI":"10.25011\/cim.v36i3.19723","volume":"36","author":"R Fowler","year":"2013","unstructured":"Fowler R, Hammer M. End-of-Life Care in Canada. Clin Invest Med. 2013;36(3):127.","journal-title":"Clin Invest Med"},{"issue":"2","key":"2898_CR8","doi-asserted-by":"publisher","first-page":"E306","DOI":"10.9778\/cmajo.20180097","volume":"7","author":"AD Hill","year":"2019","unstructured":"Hill AD, Stukel TA, Fu L, Scales DC, Laupacis A, Rubenfeld GD, et al. Trends in site of death and health care utilization at the end of life: a population-based cohort study. CMAJ Open. 2019;7(2):E306\u201315.","journal-title":"CMAJ Open"},{"issue":"1","key":"2898_CR9","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1111\/nhs.12320","volume":"19","author":"E Manning","year":"2017","unstructured":"Manning E, Gagnon M. The complex patient: a concept clarification. Nurs Health Sci. 2017;19(1):13\u201321.","journal-title":"Nurs Health Sci"},{"issue":"S3","key":"2898_CR10","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1007\/s11606-007-0307-0","volume":"22","author":"MM Safford","year":"2007","unstructured":"Safford MM, Allison JJ, Kiefe CI. Patient complexity: more Than Comorbidity. The Vector Model of Complexity. J Gen Intern Med. 2007;22(S3):382\u201390.","journal-title":"J Gen Intern Med"},{"issue":"4","key":"2898_CR11","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1370\/afm.983","volume":"7","author":"JM Valderas","year":"2009","unstructured":"Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: Implications for Understanding Health and Health Services. Annals Family Med. 2009;7(4):357\u201363.","journal-title":"Annals Family Med"},{"issue":"3","key":"2898_CR12","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1016\/j.healthpol.2006.10.003","volume":"82","author":"E Jakobsson","year":"2007","unstructured":"Jakobsson E, Bergh I, Ohlen J, Oden A, Gaston-Johansson F. Utilization of health-care services at the end-of-life. Health Policy. 2007;82(3):276\u201387.","journal-title":"Health Policy"},{"issue":"1","key":"2898_CR13","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1186\/1472-6963-10-306","volume":"10","author":"R Moineddin","year":"2010","unstructured":"Moineddin R, Nie JX, Wang L, Tracy CS, Upshur RE. Measuring change in health status of older adults at the population level: the transition probability model. BMC Health Serv Res. 2010;10(1):306.","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"2898_CR14","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1377\/hlthaff.27.3.759","volume":"27","author":"DM Berwick","year":"2008","unstructured":"Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759\u201369.","journal-title":"Health Aff (Millwood)"},{"issue":"6","key":"2898_CR15","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1370\/afm.1713","volume":"12","author":"T Bodenheimer","year":"2014","unstructured":"Bodenheimer T, Sinsky C. From Triple to Quadruple Aim: care of the patient requires care of the provider. Annals Family Med. 2014;12(6):573\u20136.","journal-title":"Annals Family Med"},{"issue":"18","key":"2898_CR16","doi-asserted-by":"publisher","first-page":"2387","DOI":"10.1001\/jama.289.18.2387","volume":"289","author":"JR Lunney","year":"2003","unstructured":"Lunney JR. Patterns of Functional decline at the end of life. JAMA. 2003;289(18):2387.","journal-title":"JAMA"},{"issue":"7498","key":"2898_CR17","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1136\/bmj.330.7498.1007","volume":"330","author":"SA Murray","year":"2005","unstructured":"Murray SA, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. BMJ. 2005;330(7498):1007\u201311.","journal-title":"BMJ"},{"issue":"1","key":"2898_CR18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s13755-017-0020-2","volume":"5","author":"J Pinaire","year":"2017","unstructured":"Pinaire J, Az\u00e9 J, Bringay S, Landais P. Patient healthcare trajectory. An essential monitoring tool: a systematic review. Health Inf Sci Syst. 2017;5(1):1.","journal-title":"Health Inf Sci Syst"},{"issue":"9","key":"2898_CR19","doi-asserted-by":"publisher","first-page":"e012340","DOI":"10.1136\/bmjopen-2016-012340","volume":"6","author":"J Ambl\u00e0s-Novellas","year":"2016","unstructured":"Ambl\u00e0s-Novellas J, Murray SA, Espaulella J, Martori JC, Oller R, Martinez-Mu\u00f1oz M, et al. Identifying patients with advanced chronic conditions for a progressive palliative care approach: a cross-sectional study of prognostic indicators related to end-of-life trajectories. BMJ Open. 2016;6(9):e012340.","journal-title":"BMJ Open"},{"issue":"1","key":"2898_CR20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00392-016-1025-6","volume":"106","author":"MR Cowie","year":"2017","unstructured":"Cowie MR, Blomster JI, Curtis LH, Duclaux S, Ford I, Fritz F, et al. Electronic health records to facilitate clinical research. Clin Res Cardiol. 2017;106(1):1\u20139.","journal-title":"Clin Res Cardiol"},{"issue":"2","key":"2898_CR21","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1111\/j.1468-0009.2007.00483.x","volume":"85","author":"J Lynn","year":"2007","unstructured":"Lynn J, Straube BM, Bell KM, Jencks SF, Kambic RT. Using Population Segmentation to provide Better Health Care for all: the bridges to Health Model. Milbank Q. 2007;85(2):185\u2013208.","journal-title":"Milbank Q"},{"key":"2898_CR22","doi-asserted-by":"crossref","unstructured":"Ristevski B, Chen M. Big Data Analytics in Medicine and Healthcare. J Integr Bioinform. 2018;15(3).","DOI":"10.1515\/jib-2017-0030"},{"issue":"5","key":"2898_CR23","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1111\/j.1365-2753.2008.01068.x","volume":"15","author":"K Vanhaecht","year":"2009","unstructured":"Vanhaecht K, De Witte K, Panella M, Sermeus W. Do pathways lead to better organized care processes? J Eval Clin Pract. 2009;15(5):782\u20138.","journal-title":"J Eval Clin Pract"},{"key":"2898_CR24","doi-asserted-by":"publisher","first-page":"103994","DOI":"10.1016\/j.jbi.2022.103994","volume":"127","author":"J Munoz-Gama","year":"2022","unstructured":"Munoz-Gama J, Martin N, Fernandez-Llatas C, Johnson OA, Sep\u00falveda M, Helm E, et al. Process mining for healthcare: characteristics and challenges. J Biomed Inform. 2022;127:103994.","journal-title":"J Biomed Inform"},{"issue":"6","key":"2898_CR25","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1186\/s12911-023-02113-7","volume":"22","author":"E Tavazzi","year":"2023","unstructured":"Tavazzi E, Gatta R, Vallati M, Cotti Piccinelli S, Filosto M, Padovani A, et al. Leveraging process mining for modeling progression trajectories in amyotrophic lateral sclerosis. BMC Med Inf Decis Mak. 2023;22(6):346.","journal-title":"BMC Med Inf Decis Mak"},{"issue":"1","key":"2898_CR26","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1038\/s41746-024-01297-0","volume":"7","author":"M Winter","year":"2024","unstructured":"Winter M, Langguth B, Schlee W, Pryss R. Process mining in mHealth data analysis. Npj Digit Med. 2024;7(1):299.","journal-title":"Npj Digit Med"},{"key":"2898_CR27","unstructured":"R Core Team. R: A language and environment for statistical computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing. 2021. Available from: https:\/\/www.R-project.org\/"},{"key":"2898_CR28","unstructured":"Janssenswillen G, bupaR. Business Process Analysis in R [Internet]. 2022. Available from: https:\/\/CRAN.R-project.org\/package=bupaR"},{"key":"2898_CR29","unstructured":"INSPQ. End-of-life palliative care in Quebec: definition and measurement of indicators [Soins palliatifs de fin de vie au Qu\u00e9bec: D\u00e9finition et mesure d\u2019indicateurs] [Internet]. Qu\u00e9bec: Direction syst\u00e8mes de soins et services, Institut national de sant\u00e9 publique du Qu\u00e9bec. 2006. (Rersearch report). Available from: https:\/\/www.inspq.qc.ca\/en\/node\/2526"},{"key":"2898_CR30","unstructured":"INSPQ. Palliative care indicators: update of results for the adult population of Quebec. (2002\u20132016) [Indicateurs de soins palliatifs: mise \u00e0 jour des r\u00e9sultats pour la population adulte du Qu\u00e9bec (2002\u20132016)] [Internet]. INSPQ; 2020 Dec p. 80. (Research report). Available from: https:\/\/www.inspq.qc.ca\/en\/node\/27136"},{"key":"2898_CR31","unstructured":"INESSS. Portrait of the use of home care and support services by people at the end-stages of life in Qu\u00e9bec, 2013\u20132018 [Internet]. Qu\u00e9bec: INESSS. 2021 Dec p. 52. Available from: https:\/\/www.inesss.qc.ca\/en\/publications\/publications\/publication\/portrait-of-the-use-of-home-care-and-support-services-by-people-at-the-end-stages-of-life-in-quebec-2013-2018.html"},{"issue":"1","key":"2898_CR32","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1186\/s12875-022-01850-4","volume":"23","author":"MA Smithman","year":"2022","unstructured":"Smithman MA, Haggerty J, Gaboury I, Breton M. Improved access to and continuity of primary care after attachment to a family physician: longitudinal cohort study on centralized waiting lists for unattached patients in Quebec, Canada. BMC Prim Care. 2022;23(1):238.","journal-title":"BMC Prim Care"},{"issue":"3","key":"2898_CR33","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1111\/j.1468-0009.2005.00409.x","volume":"83","author":"B Starfield","year":"2005","unstructured":"Starfield B, Shi L, Macinko J. Contribution of primary care to Health Systems and Health. Milbank Q. 2005;83(3):457\u2013502.","journal-title":"Milbank Q"},{"issue":"4","key":"2898_CR34","doi-asserted-by":"publisher","first-page":"e021147","DOI":"10.1136\/bmjopen-2017-021147","volume":"8","author":"H Seow","year":"2018","unstructured":"Seow H, O\u2019Leary E, Perez R, Tanuseputro P. Access to palliative care by disease trajectory: a population-based cohort of Ontario decedents. BMJ Open. 2018;8(4):e021147.","journal-title":"BMJ Open"},{"key":"2898_CR35","doi-asserted-by":"publisher","first-page":"108806","DOI":"10.1016\/j.asoc.2022.108806","volume":"122","author":"B Fatimah","year":"2022","unstructured":"Fatimah B, Aggarwal P, Singh P, Gupta A. A comparative study for predictive monitoring of COVID-19 pandemic. Appl Soft Comput. 2022;122:108806.","journal-title":"Appl Soft Comput"},{"key":"2898_CR36","doi-asserted-by":"publisher","unstructured":"van der Aalst WMP, Carmona J, editors. Process Mining Handbook [Internet]. Cham: Springer International Publishing; 2022 [cited 2023 Mar 6]. (Lecture Notes in Business Information Processing; vol. 448). Available from: https:\/\/link.springer.com\/https:\/\/doi.org\/10.1007\/978-3-031-08848-3","DOI":"10.1007\/978-3-031-08848-3"},{"key":"2898_CR37","doi-asserted-by":"crossref","unstructured":"Teinemaa I, Dumas M, La Rosa M, Maggi F. Outcome-oriented predictive process monitoring: review and Benchmark. ACM Trans Knowl Discov Data 13(2).","DOI":"10.1145\/3301300"},{"issue":"2","key":"2898_CR38","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1007\/s10462-021-09960-8","volume":"55","author":"DA Neu","year":"2022","unstructured":"Neu DA, Lahann J, Fettke P. A systematic literature review on state-of-the-art deep learning methods for process prediction. Artif Intell Rev. 2022;55(2):801\u201327.","journal-title":"Artif Intell Rev"},{"issue":"2","key":"2898_CR39","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.is.2011.01.003","volume":"37","author":"\u00c1 Rebuge","year":"2012","unstructured":"Rebuge \u00c1, Ferreira DR. Business process analysis in healthcare environments: a methodology based on process mining. Inform Syst. 2012;37(2):99\u2013116.","journal-title":"Inform Syst"},{"key":"2898_CR40","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1007\/978-3-319-98648-7_27","volume-title":"Business process management","author":"C Di Francescomarino","year":"2018","unstructured":"Di Francescomarino C, Ghidini C, Maggi FM, Milani F. Predictive process monitoring methods: which one suits me best? In: Weske M, Montali M, Weber I, vom Brocke J, editors. Business process management. Cham: Springer International Publishing; 2018. pp. 462\u201379. (Lecture Notes in Computer Science)."},{"key":"2898_CR41","first-page":"250","volume-title":"Data smog: surviving the information glut","author":"D Shenk","year":"1997","unstructured":"Shenk D. Data smog: surviving the information glut. USA: HarperCollins; 1997. p. 250."},{"key":"2898_CR42","unstructured":"Government of Quebec. More human, more efficient - plan to implement the necessary changes in health [Plus Humain et plus performant - plan pour mettre en oeuvre les changements n\u00e9cessaires en sant\u00e9]. Ministry of Health and Social Services; 2022. p. 90."},{"key":"2898_CR43","unstructured":"MSSS. Regulatory framework\u2013 Information system on CLSC customers and services [Cadre normatif\u2013 Syst\u00e8me d\u2019information sur la client\u00e8le et les services des CLSC (I-CLSC)] [Internet]. Qu\u00e9bec, Qc. 2015 p. 599. Available from: https:\/\/www.bibliotheque.assnat.qc.ca\/DepotNumerique_v2\/AffichageFichier.aspx?idf=152162"},{"key":"2898_CR44","unstructured":"ISO. ISO\/IEC 19510. 2013(en), Information technology \u2014 Object Management Group Business Process Model and Notation [Internet]. 2013 [cited 2022 Dec 6]. Available from: https:\/\/www.iso.org\/obp\/ui\/fr\/#iso:std:iso-iec:19510:ed-1:v1:en"},{"issue":"5","key":"2898_CR45","first-page":"695","volume":"73","author":"J Cohen-Mansfield","year":"2018","unstructured":"Cohen-Mansfield J, Cohen R, Skornick-Bouchbinder M, Brill S. What is the end of Life Period? Trajectories and characterization based on primary caregiver reports. Journals Gerontology: Ser A. 2018;73(5):695\u2013701.","journal-title":"Journals Gerontology: Ser A"}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-025-02898-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12911-025-02898-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-025-02898-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T11:29:45Z","timestamp":1738754985000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-025-02898-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,5]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["2898"],"URL":"https:\/\/doi.org\/10.1186\/s12911-025-02898-9","relation":{},"ISSN":["1472-6947"],"issn-type":[{"value":"1472-6947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,5]]},"assertion":[{"value":"1 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 January 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 February 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"According to the following legislation \u201cI-1303- Loi sur l\u2019Institut National d\u2019Excellence en Sant\u00e9 et en Services Sociaux (INESSS)\u201d, the INESSS benefits from a tripartite agreement with the health insurer \u201cR\u00e9gie de l\u2019Assurance Maladie du Qu\u00e9bec\u201d (RAMQ) and the Ministry of Health and Social Services (MSSS), allowing the institute access to data related to its mission, without ethical approval nor consent needed. As end-of-life care is among the major objectives of the INESSS Triennial Plan of Activities, DBR was able to perform all the analyses during a partnership between the University of Montreal and the INESSS. No other authors were able to access the data. No consent was needed from the participants for this retrospective cohort of deceased people. The study and ethical exemption as described above has been approved by the University of Montreal review board (CERSES 2024\u20136300).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"58"}}