For every numerator, you need a denominator: A simple statement but key tomeasuring the quality of care of the "dying"

A mathematical rate is composed of a numerator; denominator, and time perio d of observation. Deciding who is in the denominator is a key, yet difficul t task given the blurred boundaries of chronic illness, in examining the qu ality of care for dying patients. We propose two potential solutions. First , one could prospectively define the outcome state of "living with life-thr eatening'' illness, where there is life expectancy of 1 or 2 years. Second retrospective interviews could be used with family members or other loved o nes about their perceptions of the quality of care in the last weeks of lif e. Improving the quality of care for dying patients and their families requ ires attention to this matter. J Pain Symptom Manage 1999;17:109-113. (C) U .S. Cancer Pain Relief Committee, 1999.