Evaluating quality of care at the end of life and setting best practice performance standards: a population-based observational study using linked routinely collected administrative databases

BMC Palliative Care

Yvonne Engels¹  Anna K. L. Reyners²  Agnes van der Heide³  Bregje D. Onwuteaka-Philipsen⁴  Manon S. A. Boddaert⁵  Marianne J. Heins⁶  Mariska G. Oosterveld-Vlug⁶  Anneke L. Francke⁶ 

[1] Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center;Department of Medical Oncology, Center of Expertise in Palliative Care, University Medical Centre Groningen, University of Groningen;Department of Public Health, Erasmus MC, University Medical Center Rotterdam;Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam;Netherlands Comprehensive Cancer Organisation (IKNL);Netherlands Institute for Health Services Research (Nivel);

关键词: End-of-life care;    Quality indicators;    Routinely collected health data;    Benchmarking;    Performance standards;    Place of death;   

DOI  :  10.1186/s12904-022-00927-2

来源: DOAJ

【 摘 要 】

Abstract Background A high percentage of people dying at home, and a low percentage of people being admitted to hospital and dying there are regarded as indicators of appropriate care at the end of life. However, performance standards for these quality indicators are often lacking, which makes it difficult to state whether an indicator score falls between the ranges of good or poor quality care. The aim of this study was to assess quality indicators concerning place of death and hospital care utilization in people with diseases relevant for palliative care, and to establish best practice performance standards based on indicator scores in 31 regions in the Netherlands. Methods A retrospective nationwide population-based observational study was conducted, using routinely collected administrative data concerning persons who died in 2017 in the Netherlands with underlying causes relevant for palliative care (N = 109,707). Data from four registries were linked for analysis. Scores on eight quality indicators concerning place of death and hospital care utilization were calculated, and compared across 31 healthcare insurance regions to establish relative benchmarks. Results On average, 36.4% of the study population died at home (range between regions 30.5%-42.6%) and 20.4% in hospital (range 16.6%-25.5%). Roughly half of the population who received hospital care at any time in the last year of life were found to (also) receive hospital care in the last month of life. In the last month, 32.0% of the study population were admitted to hospital (range 29.4-36.4%), 5.3% to an Intensive Care Unit (range 3.2-6.9%) and 23.9% visited an Emergency Department (range 21.0-27.4%). In the same time period, less than 1% of the study population was resuscitated in hospital or received tube or intravenous feeding in hospital. Conclusions The variation between regions points towards opportunities for practice improvement. The best practice performance standards as set in this study serve as ambitious but attainable targets for those regions that currently do not meet the standards. Policymakers, healthcare providers and researchers can use the suggested performance standards to further analyze causes of variance between regions and develop and test interventions that can improve practice.

【 授权许可】

Unknown