Yasuhiro Hamatani1, Yasuko Takada2, Yoshihiro Miyamoto3, Yukie Kawano2, Yuta Anchi1, Tatsuhiro Shibata4, Atsushi Suzuki5, Mitsunori Nishikawa6, Hiroto Ito7,8, Masashi Kato9, Tsuyoshi Shiga5, Yoshihiro Fukumoto4, Chisato Izumi1, Satoshi Yasuda1, Hisao Ogawa1, Yasuo Sugano1, Toshihisa Anzai1,10. 1. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center. 2. Department of Nursing, National Cerebral and Cardiovascular Center. 3. Division of Data Management, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center. 4. Division of Cardiovascular Medicine, Kurume University School of Medicine. 5. Department of Cardiology, Tokyo Women's Medical University. 6. Department of Palliative Care, National Center for Geriatrics and Gerontology. 7. National Center of Neurology and Psychiatry. 8. Japan Organization of Occupational Health and Safety. 9. Department of Psycho-Oncology, National Cancer Center. 10. Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine.
Abstract
BACKGROUND: Palliative care is highly relevant for patients with heart failure (HF), and there is a need for quantitative information on quality of care. Accordingly, this study aimed to develop a set of quality indicators (QIs) for palliative care of HF patients, and to conduct a practical pilot measurement of the proposed QIs in clinical practice.Methods and Results: We used a modified Delphi technique, a consensus method that involves a comprehensive literature review, face-to-face multidisciplinary panel meeting, and anonymous rating in 2 rounds. A 15-member multidisciplinary expert panel individually rated each potential indicator on a scale of 1 (lowest) to 9 (highest) for appropriateness. All indicators receiving a median score ≥7 without significant disagreement were included in the final set of QIs. Through the consensus-building process, 35 QIs were proposed for palliative care in HF patients. Practical measurement in HF patients (n=131) from 3 teaching hospitals revealed that all of the proposed QIs could be obtained retrospectively from medical records, and the following QIs had low performance (<10%): "Intervention by multidisciplinary team", "Opioid therapy for patients with refractory dyspnea", and "Screening for psychological symptoms". CONCLUSIONS: The first set of QIs for palliative care of HF patients was developed and could clarify quantitative information and might improve the quality of care.
BACKGROUND: Palliative care is highly relevant for patients with heart failure (HF), and there is a need for quantitative information on quality of care. Accordingly, this study aimed to develop a set of quality indicators (QIs) for palliative care of HFpatients, and to conduct a practical pilot measurement of the proposed QIs in clinical practice.Methods and Results: We used a modified Delphi technique, a consensus method that involves a comprehensive literature review, face-to-face multidisciplinary panel meeting, and anonymous rating in 2 rounds. A 15-member multidisciplinary expert panel individually rated each potential indicator on a scale of 1 (lowest) to 9 (highest) for appropriateness. All indicators receiving a median score ≥7 without significant disagreement were included in the final set of QIs. Through the consensus-building process, 35 QIs were proposed for palliative care in HFpatients. Practical measurement in HFpatients (n=131) from 3 teaching hospitals revealed that all of the proposed QIs could be obtained retrospectively from medical records, and the following QIs had low performance (<10%): "Intervention by multidisciplinary team", "Opioid therapy for patients with refractory dyspnea", and "Screening for psychological symptoms". CONCLUSIONS: The first set of QIs for palliative care of HFpatients was developed and could clarify quantitative information and might improve the quality of care.