Comprehensive set of quality indicators for palliative care
This study aimed at developing, testing and evaluating the comprehensive set of quality indicators for palliative care by using the set (or a part of the set) in a population of palliative patients. Therefore we asked caregivers to use an adjusted set (specific to the population and setting) of quality indicators on patients receiving care from a specialized palliative service. Questionnaires for patients, caregivers and next-of-kin were used to score the indicators as prescribed in a manual. We also asked all respondents to fill in an evaluation form, to provide information about the usability, measurability and necessity of time to score the indicators in practice. On the basis of this evaluation we were able to adjust and improve the indicator set and the manual.
A second goal of this study was to prepare implementation of the indicators in all palliative care services in Flanders. Therefore we explored possible barriers and facilitators using focus group interviews in order to develop an implementation strategy and training.
This study was the preparation for a wider implementation project in which as many specialized palliative care services as possible will be using the quality indicator set in order to internally monitor and evaluate the quality of the palliative care delivered. The new and current projects can be found here on the website.
For more information on the current implementation of the quality indicators into the Flemish palliative care services, please visit endoflifecare.be/kwaliteitsindicatoren.
Quality of palliative care is of interest to everyone receiving or delivering it. Quality indicators are defined as measurable aspects of care referring to structure, process, or outcome and are mostly measured on individual level but interpreted as aggregated, e.g. at service level. Quality indicator scores can be used to evaluate which aspects of the care are going well and which are not going and have room for improvement.
To develop a comprehensive quality indicator set reflecting the multidisciplinary and multifaceted character of palliative care.
Methods and results
The study involved a three-step development process, resulting in a minimal indicator set and three optional thematic modules that can be used to monitor and improve the quality of palliative care within the specialized palliative care services in Flanders, Belgium. In the first step the quality indicator set was developed by means of a systematic literature review and an expert panel. Second, the comprehensive quality indicator set was tested for feasibility and usefulness in nine specialized palliative care services by using a mixed-methods design. Overall the caregivers found the indicator set and measurement procedure feasible and useful. Based on this testing, the set and measurement procedure were fine-tuned and an expert panel was organized to select a minimal indicator set for quick and efficient quality monitoring. Last, barriers and facilitators were identified for implementation of the quality indicators into palliative care services in Flanders.
We managed to develop a comprehensive quality indicator set for the field of palliative care with accompanying measurement procedure that is feasible for caregivers to work with. Although the quality indicator set is ready to be used by the specialized palliative care services to internally monitor and improve the quality of care, further research is necessary to validate the indicator set for large populations and to measure its effect on patient and family outcomes.