Kathleen Leemans, Junior Researcher, and Joachim Cohen, Senior Researcher, End of Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Belgium, explain the background to their longer article that is published in the September/October edition of the European Journal of Palliative Care.
Many palliative care teams are searching for ways to prove that they are doing their job well and to measure the quality of the care they provide. Quality indicators can be used for these purposes. They are well-defined and measurable aspects of care, expressed in a percentage, which are used to evaluate the quality of care. Not only policy makers and managers are interested in the result of such quality measurements, but also caregivers can use quality indicator scores to improve their structures, processes and outcomes of care.
Therefore, in Belgium we developed a comprehensive quality indicator set for quality improvement within palliative care services consisting of a default minimal set (31 indicators) and three optional thematic modules. Data to calculate the indicators are gathered twice a year from three different perspectives (patients, family and caregivers), concerning eight different domains of palliative care (physical and psychosocial aspects of care, communication and care planning, type of care and circumstances surrounding death, coordination and continuity of care and care for the family).
However, many caregivers are worried about the time investment they will have to make if they decide to start working with quality indicators. Will they still be able to spend the time that is needed at the bedside of their patients? These patients are at the end of their lives, hence are very vulnerable and cannot be harmed by measuring quality of care. Although it is acknowledged that reflectiveness about the quality of care is important, many caregivers are reluctant to measure quality and use indicators as they feel it is not at the core of their job.
Each time we tell palliative caregivers how much time it actually takes to measure the quality of care of their team with the quality indicator set we developed, they initially do not believe it. The whole measurement procedure – from selecting eligible patients, sending out the questionnaires to handing over all completed questionnaires to the researchers – takes approximately two full days of work from the person responsible within the team over a period of two months. After data collection, the palliative care services can use the quality indicator scores to evaluate several aspects of their care and hence improve it where it is deemed necessary.
In the long run, once several palliative care services are using the quality indicators, they will be able to compare themselves against other services and learn from each other’s best practices. Still, in order to do so, healthcare policy-makers need to create the conditions that will allow the quality indicators to be integrated in the daily functioning of the palliative care services. Once quality indicators can be measured systematically, they can serve as an important tool for monitoring and optimizing the quality of palliative care for patients and their families.
To read a copy of the full article…
This post relates to a longer article, ‘How can palliative care services prove that they are delivering good care? Monitoring the quality of palliative care using quality indicators’ by Joachim Cohen and Kathleen Leemans published in the September/October 2014 issue of the European Journal of Palliative Care (vol. 21.5). If you have a web-based subscription to the journal you can download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.
Links and resources
The EAPC Task Force on Patient-reported Outcome Measurement in Palliative Care.
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