scholarly journals The use of quality indicators (QIs) to evaluate the oncologic care in CCCN: a systematic review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
R A Cocchiara ◽  
A Mannocci ◽  
S Cianfanelli ◽  
C Sestili ◽  
V D’Egidio ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Cancer Patients ◽  
Quality Indicators ◽  
Clinical Care ◽  
Integrated Approach ◽  
Care Quality ◽  
Process Of Care ◽  
Oncological Patients ◽  
Abstract Screening

Abstract Due to the increase of life expectancy for cancer patients, it has become necessary to implement complete and economically sustainable clinical care pathways that integrate different professional competences. The Comprehensive Cancer Care Network (CCCN) model consists of multiple specialized structures that cooperate for cancer patients care. Quality Indicators (QIs) represent valid and reliable tools of evaluation that allow a standardized comparison among different structures. The aim of this systematic review was to highlight a wide and complete description of the implemented QIs within the CCCNs and to identify and analyze methodologies used for the development of QIs. The literature was performed investigating two databases (PubMed and Scopus) and the search identified 7342 studies. After duplicate removal, title and abstract screening, and full text evaluation, 46 studies were included in the study. Most QIs were implemented in USA, Germany and Italy where the CCCN approach seems to be well defined. Eighty -two QIs concerned diagnosis, 260 concerned treatment, 7 concerned prevention, 29 about follow up, 71 about palliative care, 12 concerned rehabilitation and 7 research. The majority of the identified QIs belonged to the process domain, followed by the structure ones. Excluding QIs related to the management of cancer in general, the most represented organs resulted breast, colorectum and lung. Overall, it can be stated that the most represented categories of QIs concerned diagnosis and treatment. Furthermore, also the palliative care domain appeared very represented. Regarding the methodology of the QIs development, a consensus approach among experts and the Delphi method were the most frequently used methodologies. Only a few studies included the participation of patients for the implementation of the QIs. This systematic review provides a synthesis of existing QIs related to the setting of integrated oncological care Key messages The CCCN has been recognized as an ideal model for structuring the process of care that guarantees a complete and integrated approach for the management of oncological patients. Quality Indicators represent valid and reliable tools that should be used to perform a standardized comparison among different healthcare systems and to guarantee a homogeneous quality of care.

Toward proven and prioritized quality measures: Which ASCO QOPI and other supportive care measures associate with improved quality of life (QOL)?

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 165-165
Author(s):  
Arif Kamal ◽  
Janet Bull ◽  
Amy Pickar Abernethy
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Supportive Care ◽  
Cancer Patients ◽  
Clinical Care ◽  
Performance Status ◽  
Quality Measures ◽  
Well Being ◽  
Care Quality ◽  
The Impact

165 Background: An expanding array of quality measures, including the Quality Oncology Practice Initiative (QOPI) metrics, is being developed for oncology. To date, evidence demonstrating the impact of each metric on outcomes, ultimately aiding in prioritization of individual measures, remains immature. We investigated the relationship between conformance with quality measures and higher patient QOL among cancer patients receiving palliative care. Methods: A comprehensive systematic review of PUBMED and the gray literature (1995-2012) identifed all described supportive care quality measures. Patients receiving palliative care in 4 community-based programs were entered into a longitudinal quality registry; analyses focused on cancer patients registered between 6/08-10/11. To find predictors of higher QOL, conformance cohorts were examined for demographic variables, performance status (measured by palliative performance scale, PPS) and provider estimation of prognosis and included in univariate and multivariate regression. Results: The systematic review yielded 303 quality measures. Of these, 18 measures, representing components of the ASCO QOPI, Hospice PEACE, and Cancer-ASSIST measure sets, were evaluable using registry data. 460 cancer patients were included. 60% of patients had weeks to 6 months expected prognosis. Among QOPI measures, conformance with two measures was significantly associated with better QOL: constipation assessment at time of narcotic prescription and emotional well-being assessment (both p<0.05). Other significant findings were conformance with screening of symptoms at first visit (p=0.017), timely treatment for uncontrolled dyspnea (p=0.005), and assessment of fatigue (p=0.007). In a multivariate model predicting higher QOL, measures involving emotional well-being assessment (OR 1.60; p=0.026) and screening of symptoms (OR 1.74, p=0.008) remained significant. Conclusions: Clinical care that conforms to quality measures reflecting regular symptom and emotional assessment is significantly associated with better patient experiences (QOL) and should be prioritized in quality assessment efforts.

Hospital quality indicators: a systematic review

2019 ◽  
Vol 32 (2) ◽  
pp. 474-487 ◽  
Author(s):  
Juliana Zeni Breyer ◽  
Juliana Giacomazzi ◽  
Regina Kuhmmer ◽  
Karine Margarites Lima ◽  
Luciano Serpa Hammes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Indicators ◽  
Emergency Services ◽  
Clinical Care ◽  
Grey Literature ◽  
Professional Associations ◽  
Hospital Quality ◽  
Healthcare Organizations ◽  
Content Type ◽  
Process And Outcome

PurposeThe purpose of this paper is to identify and describe hospital quality indicators, classifying them according to Donabedian’s structure, process and outcome model and in specific domains (quality, safety, infection and mortality) in two care divisions: inpatient and emergency services.Design/methodology/approachA systematic review identified hospital clinical indicators. Two independent investigators evaluated 70 articles/documents located in electronic databases and nine documents from the grey literature, 35 were included in the systematic review.FindingsIn total, 248 hospital-based indicators were classified as infection, safety, quality and mortality domains. Only 10.2 percent were identified in more than one article/document and 47 percent showed how they were calculated/obtained. Although there are scientific papers on developing, validating and hospital indicator assessment, most indicators were obtained from technical reports, government publications or health professional associations.Research limitations/implicationsThis review identified several hospital structure, process and outcome quality indicators, which are used by different national and international groups in both research and clinical practice. Comparing performance between healthcare organizations was difficult. Common clinical care standard indicators used by different networks, programs and institutions are essential to hospital quality benchmarking.Originality/valueTo the authors’ knowledge, this is the first systematic review to identify and describe hospital quality indicators after a comprehensive search in MEDLINE/PubMed, etc., and the grey literature, aiming to identify as many indicators as possible. Few studies evaluate the indicators, and most are found only in the grey literature, and have been published mostly by government agencies. Documents published in scientific journals usually refer to a specific indicator or to constructing an indicator. However, indicators most commonly found are not supported by reliability or validity studies.

scholarly journals Real-world ethics in palliative care: A systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice

2020 ◽  
pp. 026921632097427
Author(s):  
Guy Schofield ◽  
Mariana Dittborn ◽  
Richard Huxtable ◽  
Emer Brangan ◽  
Lucy Ellen Selman
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Clinical Practice ◽  
Ethical Issues ◽  
Clinical Care ◽  
Ethical Principles ◽  
Original Research ◽  
Specialist Palliative Care ◽  
Ethical Challenges ◽  
Ethical Practice

Background: Ethical issues arise daily in the delivery of palliative care. Despite much (largely theoretical) literature, evidence from specialist palliative care practitioners about day-to-day ethical challenges has not previously been synthesised. This evidence is crucial to inform education and adequately support staff. Aim: To synthesise the evidence regarding the ethical challenges which specialist palliative care practitioners encounter during clinical practice. Design: Systematic review with narrative synthesis (PROSPERO registration CRD42018105365). Quality was dual-assessed using the Mixed-Methods Appraisal Tool. Tabulation, textural description, concept mapping and thematic synthesis were used to develop and present the narrative. Data sources: Seven databases (MEDLINE, Philosopher’s Index, EMBASE, PsycINFO, LILACS, Web of Science and CINAHL) were searched from inception to December 2019 without language limits. Eligible papers reported original research using inductive methods to describe practitioner-reported ethical challenges. Results: A total of 8074 records were screened. Thirteen studies from nine countries were included. Challenges were organised into six themes: application of ethical principles; delivering clinical care; working with families; engaging with institutional structures and values; navigating societal values and expectations; philosophy of palliative care. Challenges related to specific scenarios/contexts rather than the application of general ethical principles, and occurred at all levels (bedside, institution, society, policy). Conclusion: Palliative care practitioners encounter a broad range of contextual ethical challenges, many of which are not represented in palliative care ethics training resources, for example, navigating institutional policies, resource allocation and inter-professional conflict. Findings have implications for supporting ethical practice and training practitioners. The lack of low- and middle- income country data needs addressing.

Assessment tools for palliative care.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 66-66
Author(s):  
Sarina Isenberg ◽  
Rebecca Aslakson ◽  
Sydney Morss Dy ◽  
Renee Wilson ◽  
Julie Waldfogel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Clinical Practice ◽  
Quality Indicators ◽  
Systematic Reviews ◽  
Grey Literature ◽  
Care Quality ◽  
Assessment Tools ◽  
Patient Reported

66 Background: Recent reviews have not comprehensively addressed palliative care (PC) assessment tools. This project summarizes the extent of evidence about PC assessment tools for patients and families, and how tools have been used for clinical care, quality indicators, and evaluation of interventions. Methods: We searched MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews for systematic reviews of assessment tools for PC, from January 2007 to March 2016. We searched the grey literature for domains without systematic reviews, and for domains with systematic reviews > three years old. Paired investigators independently screened search results and grey literature to determine eligibility, and assessed risk of bias of systematic reviews. The team selected the most recent and highest-quality systematic reviews for each domain. One investigator abstracted information, and a second investigator checked the information. Results: Using the National Consensus Project Palliative Care Guidelines domains, we included nine systematic reviews with 167 tools, and six tools from grey literature. Most tools were in physical, psychological, psychiatric, and social aspects of care, care at the end of life, and tools that cross domains (quality of life and caregiver-reported experience). Only two tools directly addressed spiritual aspects and none addressed cultural or patient-reported experience. Internal consistency reliability was evaluated for almost all tools; most reported construct validity; and few reported responsiveness (sensitivity to change). Few studies evaluated the use of assessment tools in quality indicators or clinical practice. A systematic review of 38 PC interventions and the assessment tools used found that at least 25 interventions included physical, psychosocial and psychiatric, and quality of life tools, but the tools varied extensively, and only nine included patient experience tools. Conclusions: Although assessment tools exist in many PC domains, tools are needed to assess spiritual and cultural aspects of care, and patient-reported experience. Research is needed concerning: tools in clinical practice and quality of care; comparison of existing tools; and evaluation and dissemination tools with evidence of responsiveness.

scholarly journals Association of severe mental illness with stroke outcomes and process-of-care quality indicators: nationwide cohort study

2021 ◽  
pp. 1-8
Author(s):  
Kelly Fleetwood ◽  
Sarah H. Wild ◽  
Daniel J. Smith ◽  
Stewart W. Mercer ◽  
Kirsty Licence ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Mental Illness ◽  
Cohort Study ◽  
Major Depression ◽  
Severe Mental Illness ◽  
Quality Indicators ◽  
Care Quality ◽  
Process Of Care ◽  
Vascular Events ◽  
Stroke Outcomes

Background Severe mental illness (SMI) is associated with increased stroke risk, but little is known about how SMI relates to stroke prognosis and receipt of acute care. Aims To determine the association between SMI and stroke outcomes and receipt of process-of-care quality indicators (such as timely admission to stroke unit). Method We conducted a cohort study using routinely collected linked data-sets, including adults with a first hospital admission for stroke in Scotland during 1991–2014, with process-of-care quality indicator data available from 2010. We identified pre-existing schizophrenia, bipolar disorder and major depression from hospital records. We used logistic regression to evaluate 30-day, 1-year and 5-year mortality and receipt of process-of-care quality indicators by pre-existing SMI, adjusting for sociodemographic and clinical factors. We used Cox regression to evaluate further stroke and vascular events (stroke and myocardial infarction). Results Among 228 699 patients who had had a stroke, 1186 (0.5%), 859 (0.4%), 7308 (3.2%) had schizophrenia, bipolar disorder and major depression, respectively. Overall, median follow-up was 2.6 years. Compared with adults without a record of mental illness, 30-day mortality was higher for schizophrenia (adjusted odds ratio (aOR) = 1.33, 95% CI 1.16–1.52), bipolar disorder (aOR = 1.37, 95% CI 1.18–1.60) and major depression (aOR = 1.11, 95% CI 1.05–1.18). Each disorder was also associated with marked increased risk of 1-year and 5-year mortality and further stroke and vascular events. There were no clear differences in receipt of process-of-care quality indicators. Conclusions Pre-existing SMI was associated with higher risks of mortality and further vascular events. Urgent action is needed to better understand and address the reasons for these disparities.

Palliative care quality measures: an exploratory study

2019 ◽  
pp. bmjspcare-2018-001679
Author(s):  
Alessandra Buja ◽  
Michele Rivera ◽  
Vincenzo Baldo ◽  
Marta Soattin ◽  
Ylenia Rizzolo ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Indicators ◽  
Care Service ◽  
Healthcare Providers ◽  
Palliative Care Service ◽  
Care Quality ◽  
Local Health ◽  
Monotonic Trend ◽  
Intensity Of Care ◽  
At Home

ObjectivesThe aim of this study was to investigate how palliative care service structures and processes correlate with their outputs and outcomes, measuring the latter respectively in terms of intensity of care and death at home.MethodsThe Veneto Regional Health Authorities collected a set of 37 quality indicators for the year 2016, covering the following five dimensions: service integration, service structure, accessibility, professional processes and organisational processes. Their validity was assessed by a panel of 29 palliative care experts. A score was assigned to each indicator on the basis of its relevance. Non-parametric correlations between the care quality indicators and the measures of the palliative care outputs and outcomes were investigated, along with the presence of a monotonic trend in the performance of the local health units (LHU) grouped by ‘low’, ‘medium’ or ‘high’ scores and differences between these groups of LHUs.ResultsThe data showed that palliative care service structure and professional processes were the dimensions correlating significantly with the intensity of care coefficient. An increasingly significant statistical trend was found in both the intensity of care coefficient and the proportion of deaths at home for the three groups of LHUs in terms of the professional processes dimension.ConclusionsDespite its limitations, this study brought to light some statistically significant findings that are worth investigating in larger samples. To achieve improvements in the quality of palliative care, it is important for healthcare providers to know which variables most affect the output and especially the outcomes of the services offered.

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