Robrecht De Schreye1, Dirk Houttekier1, Luc Deliens1,2, Joachim Cohen1. 1. 1 End-of-life Care Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium. 2. 2 Department of Medical Oncology, Ghent University, Ghent, Belgium.
Abstract
BACKGROUND: A substantial amount of aggressive life-prolonging treatments in the final stages of life has been reported for people with progressive life-shortening conditions. Monitoring appropriate and inappropriate end-of-life care is an important public health challenge and requires validated quality indicators. AIM: To develop indicators of appropriate and inappropriate end-of-life care for people with cancer, chronic obstructive pulmonary disease or Alzheimer's disease, measurable with population-level administrative data. DESIGN: modified RAND/UCLA appropriateness method. SETTING/PARTICIPANTS: Potential indicators were identified by literature review and expert interviews and scored in a survey among three panels of experts (one for each disease group). Indicators for which no consensus was reached were taken into group discussions. Indicators with consensus among the experts were retained for the final quality indicator sets. RESULTS: The final sets consist of 28 quality indicators for Alzheimer's disease, 26 quality indicators for cancer and 27 quality indicators for chronic obstructive pulmonary disease. The indicator sets measure aspects of aggressiveness of care, pain and symptom treatment, specialist palliative care, place of care and place of death and coordination and continuity of care. CONCLUSION: We developed a comprehensive set of quality indicators of appropriate and inappropriate end-of-life care in people with Alzheimer's disease, cancer or chronic obstructive pulmonary disease, to be used in population-level research. Our focus on administrative healthcare databases limits us to treatment and medication, excluding other important quality aspects such as communication, which can be monitored using complementary approaches. Nevertheless, our sets will enable an efficient comparison of healthcare providers, regions and countries in terms of their performance on appropriateness of end-of-life care.
BACKGROUND: A substantial amount of aggressive life-prolonging treatments in the final stages of life has been reported for people with progressive life-shortening conditions. Monitoring appropriate and inappropriate end-of-life care is an important public health challenge and requires validated quality indicators. AIM: To develop indicators of appropriate and inappropriate end-of-life care for people with cancer, chronic obstructive pulmonary disease or Alzheimer's disease, measurable with population-level administrative data. DESIGN: modified RAND/UCLA appropriateness method. SETTING/PARTICIPANTS: Potential indicators were identified by literature review and expert interviews and scored in a survey among three panels of experts (one for each disease group). Indicators for which no consensus was reached were taken into group discussions. Indicators with consensus among the experts were retained for the final quality indicator sets. RESULTS: The final sets consist of 28 quality indicators for Alzheimer's disease, 26 quality indicators for cancer and 27 quality indicators for chronic obstructive pulmonary disease. The indicator sets measure aspects of aggressiveness of care, pain and symptom treatment, specialist palliative care, place of care and place of death and coordination and continuity of care. CONCLUSION: We developed a comprehensive set of quality indicators of appropriate and inappropriate end-of-life care in people with Alzheimer's disease, cancer or chronic obstructive pulmonary disease, to be used in population-level research. Our focus on administrative healthcare databases limits us to treatment and medication, excluding other important quality aspects such as communication, which can be monitored using complementary approaches. Nevertheless, our sets will enable an efficient comparison of healthcare providers, regions and countries in terms of their performance on appropriateness of end-of-life care.
Entities:
Keywords:
Alzheimer’s disease; Quality indicator; appropriate; chronic obstructive pulmonary disease; end of life care; neoplasms
Authors: Cassandra L Hua; Kali S Thomas; Jennifer N Bunker; Pedro L Gozalo; Emmanuelle Bélanger; Susan L Mitchell; Joan M Teno Journal: J Am Geriatr Soc Date: 2021-11-19 Impact factor: 5.562
Authors: Kieran L Quinn; Therese Stukel; Nathan M Stall; Anjie Huang; Sarina Isenberg; Peter Tanuseputro; Russell Goldman; Peter Cram; Dio Kavalieratos; Allan S Detsky; Chaim M Bell Journal: BMJ Date: 2020-07-06
Authors: Joanna M Davies; Katherine E Sleeman; Javiera Leniz; Rebecca Wilson; Irene J Higginson; Julia Verne; Matthew Maddocks; Fliss E M Murtagh Journal: PLoS Med Date: 2019-04-23 Impact factor: 11.069
Authors: Manon S Boddaert; Chantal Pereira; Jeroen Adema; Kris C P Vissers; Yvette M van der Linden; Natasja J H Raijmakers; Heidi P Fransen Journal: BMJ Support Palliat Care Date: 2020-12-22 Impact factor: 4.633