Palliative care quality indicators in Italy. What do we evaluate?

Abstract

Purpose In recent years, the number of palliative service providers has increased significantly. This expansion necessitates an evaluation in order to provide the basis for quality improvement of the care. Policymakers, managers of palliative care programs, and others committed to the improvement of end-of-life care need methods and criteria to measure and evaluate the care delivered. As quality measurement is expensive and difficult to undertake, it is fundamental that quality measures evaluate the right things. Quality evaluation in Italy is supported by health authorities who have developed some indicators of palliative care. The aims of this study were to give an overview of these indicators. Methods We analyzed all palliative care indicators developed by Italian national authorities from 2000 to the present. These indicators have been divided into three different levels of analysis (structure, process, and outcome). Subsequently, two reviewers have independently compared their degree of concordance with domains, and guidelines developed by the NCP for palliative care and after careful discussion an expert panel has elaborated a final consensus document. Results Most of the quality indicators analyzed deal with the structure and process of palliative care, however they miss outcomes and do not cover domains mainly concerned with spiritual, ethical, cultural, or existential aspects of care. Conclusions More attention should be paid to the development of outcome indicators of palliative care. The attempt to identify a group of indicators which cover every domain of palliative care represents a challenge for the future in terms of finding new cognitive models more oriented toward subjectivity.

Consensus on quality indicators to assess the organisation of palliative cancer and dementia care applicable across national healthcare systems and selected by international experts

“…650 QIs were selected from literature [11, 16, 18, 22, 24–54]. After having assessed these QIs, 554 were excluded because they were not about the organisation of palliative care or because of overlap; the remaining 96 QIs were included in a preliminary set of QIs (Figure 1).…”

Continuity of Care During End of Life: An Evolutionary Concept Analysis

“…With the consideration of the needs of this unique population, it can be noted in the palliative international literature that different attempts have been made to operationalize the continuity (e.g., GSF Gold Standards Framework, Project ENABLE, and Robert Wood Johnson Foundation) (Bakitas, Bishop, Caron, & Stephens, ; D'Angelo et al., ); however, attention has been given to the activities of care rather than the theoretical implications applied through the illness progression (Meier & Beresford, ). The focus of these previous continuity models was based on the building of networks with particular attention to the organizational integration, coordination, and consistency between different care settings and different members of staff, with little attention on patients’ experiences of care that underlies their satisfaction (Corrales‐Nevado et al., ).…”

Measuring indicators of health system performance for palliative and end-of-life care using health administrative data: a scoping review

“…Home care A total of 48 indicators were categorized under the home care sector 13,[16][17][18]39,42,43,52,58,65,67,68,70,72,80,87,92,99,103,110,123,128,[130][131][132][133][134][135][136] with four key measurement themes. Most indicators described patient utilization/cost of, or access to PC and/or home care services.…”

“…In recent years, jurisdictions in Canada, the United States, and the United Kingdom have focused on defining standards and monitoring health care quality as efforts to expand PC programs intensify 9-14 , and as a result a plethora of health system performance indicators for PC and EOLC using health administrative data have been proposed 13,[15][16][17][18] . These indicators have been suggested based on differing objectives (e.g.…”