On the way to a new set of quality indicators for palliative care

Existent quality indicators for palliative care mainly focus on physical aspects. Few quality indicators exist, however, for the social and spiritual domains of palliative care. A systematic review on quality indicators of palliative care of EMGO+/VUmedical center and NIVEL has been published in The Journal of Pain and Symptom Management.

Measuring quality of care
Quality-indicators are measurable aspects of care and refer to the quality of outcomes, processes or structure of care for a particular type of patients or clinical circumstances. Quality-indicators are often described as a percentage (e.g. the percentage of patients having a particular problem) and a norm (e.g. no more than 5 percent of the patients may have this particular problem). In palliative care, quality-indicators are important because they enable care providers to obtain an indication of the quality of the care that is provided and, subsequently, to improve the care where needed. When scores on quality indicators are published (e.g. on websites), patients can make a better choice between care providers. Furthermore, scores on quality indicators can provide relevant information for external parties, like the health care inspectorate.

Development
Funded by ZonMw the Netherlands organisation for health research and development, NIVEL and EMGO+-institute of VU medical centre are developing a set of quality indicators for palliative care in the Netherlands. In the first stage of the project, an international systematic review was performed to explore existent quality indicators for palliative care. Coordinator of the project Anneke Francke: “There are rather a lot of quality indicators for physical aspects of palliative care. Strikingly few indicators exist on social or spiritual aspects. It is also remarkable that existent indicators often focus on a specific field of palliative care, such as ‘palliative cancer care’ or ‘end-of-life care in nursing homes’.”
 
A broad set of indicators
One broad set of quality indicators needs to be developed for Dutch palliative care, which includes all aspects of palliative care, physical, psychosocial and spiritual. This set of indicators must be applicable in all settings in which palliative care is being delivered. In addition to the input form the systematic literature review, qualitative interviews with patients, informal carers and professionals, as well as consultation of experts have to deliver input for the quality indicators. At the end of 2009 the final report on the development of the set of indicators will be published.