Quality Indicators for Care in the Dying Phase
How Well Can They Capture Good Care and how Applicable Are They?
Presentation - May 19, 2011
Galushko Maren, Raijmakers Natasja JH, Domeisen Benedetti Franzisca, Lundh Hagelin Carina, Lindqvist Olav, Popa-Velea Ovidiu, Romotzky Vanessa, Ellershaw John, Ostgathe Christoph
last days of life
Background: OPCARE9 is a 3 year EU 7th framework project that was launched in March 2008. The aim for the 9 participating countries is to optimise research and clinical care for cancer patients in the last days of life. Within this project, one of the objectives was to identify and evaluate quality indicators (QI) against which to measure future care in the last days of life.
Method: A literature search was performed to identify QI with a numerator, a denominator and a performance standard that focus specifically on the last days of life. For an online survey among 64 European and 7 non-European experts in palliative care and/or QI development a questionnaire was developed, piloted and refined. All elected QI had to be rated on a 4-point Likert scale for being a good descriptor and being applicable in the last days of life. Comments and further QI could be added by the respondents.
Results: In total, 42 out of 71 experts (59 %) with different professional background responded, 69% directly involved in patient care and 33% in QI development. “Presence of dedicated room space for meetings on the ICU between clinicians and families” reached the highest agreement for good description and applicability, with 62% respectively 64%. Lowest agreement for both dimensions was reached by the items of the Therapy Impact Questionnaire (TIQ). Additionally, 45 QI were mentioned by the experts to be good descriptors and 17 to be applicable. Nevertheless, the quality of these differed considerably.
Conclusion: QI are necessary to optimize patient care and guarantee a standard of high quality care. However, the results of our study show that beside single items that reached high consensus, identification of a comprehensive set of useful and applicable QI for the dying phase is difficult. Therefore, existing QI have to be revised and new QI to be developed. The aim should be to have a set of indicators representing both good care and applicability in the last days of life.