Quality indicators of end-of-life cancer care: What rate is right?

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 57-57
Author(s):  
Lisa Catherine Barbera ◽  
Rinku Sutradhar ◽  
Fred Burge ◽  
Kim McGrail ◽  
Konrad Fassbender ◽  
...  
Keyword(s):  
End Of Life ◽  
Quality Indicators ◽  
Administrative Data ◽  
Significant Variation ◽  
Real World Data ◽  
Average Value ◽  
Funnel Plots ◽  
Eol Care ◽  
Resource Deployment ◽  
Age And Sex

57 Background: Many publications use administrative health care data to describe quality of care indicators at the end of life (EOL). However, very little is available to help decide on optimal rates for these indicators. The purpose of this abstract is to develop data-driven and achievable benchmark rates for EOL quality indicators using administrative data from 4 provinces in Canada. Methods: Five quality indicators of EOL care were defined and measured using linked administrative data for each of the 33 regions across British Columbia, Alberta, Ontario and Nova Scotia. These were: emergency department (ED) use, intensive care unit (ICU) admission, physician house calls (MD) and nursing visits at home (RN) prior to death, and death in hospital (DH). First, an empiric benchmark was defined by determining indicator rates among the top ranked regions to include the top decile of patients overall. Second, funnel plots were used to graph the age and sex adjusted indicator rates for each region along with the overall average value and 95% confidence limits (CL) that accounted for region size. Results: There was significant variation in rates for each indicator among the regions. Minimum and maximum rates for ED, ICU, RN, MD and DH varied approximately 2 to 4 fold across the regions with MD showing the greatest variation. Benchmark rates based on the top decile performers were: ED 34%, ICU 2%, MD 34%, RN 63%, DH 38%. With the exception of ICU, funnel plots demonstrated that mean indicator rates and their 95% CL were uniformly worse than these benchmarks even after adjusting for age and sex. Additionally, few regions met the benchmark rates. Conclusions: There is significant variation in EOL quality indicators across regions in 4 provinces in Canada. The combination of these two methods allows each region to determine its performance relative to both a benchmark and the overall average. As a result, each region is then able to gauge their performance with greater context which facilitates priority setting and resource deployment. These two methods demonstrate how decreasing variation and striving for a target can drive quality improvement. Deriving benchmark values from ‘real world’ data offers the advantage of realistically achievable targets.

Quality indicators for end-of-life breast cancer care: Is there agreement between stakeholder groups?

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16034-16034
Author(s):  
P. McIntyre ◽  
E. Grunfeld ◽  
E. Mykhalovskiy ◽  
L. Cicchelli ◽  
S. F. Dent ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Focus Groups ◽  
End Of Life ◽  
Quality Indicators ◽  
Administrative Data ◽  
Health Care Professionals ◽  
Stakeholder Groups ◽  
Group Sessions ◽  
Eol Care

16034 Background: Quality indicators (QIs) are tools designed to measure quality of care and help enhance quality through identifying areas needing improvement. Breast cancer offers a disease model to examine QIs for end-of-life (EOL) care. The objective of this study was to assess agreement among stakeholder groups in two Canadian provinces on QIs for EOL breast cancer. Methods: A qualitative study design using a modified Delphi method and focus groups at each study site. After a literature review, an expert panel identified 19 QIs that were potentially measurable using administrative data. The Delphi panels and focus group sessions incorporated the 19 QIs as discussion topics in Halifax, NS and Ottawa, Ont. The Delphi panels involved a multidisciplinary group of oncology health care professionals. Separate focus groups were conducted with women with metastatic breast cancer and bereaved caregivers. All group sessions were audio-taped, transcribed verbatim, audited and a thematic analysis was conducted. Results: A total of 23 health care professionals, 16 patients, 7 bereaved caregivers participated in the study. Participants attended only one group discussion, depending on group assigned. There was good agreement on QIs among patient and caregiver groups in both cities. The need for effective communication was identified as a major theme. The Delphi process yielded overall moderate agreement with QIs among health care professionals. Conclusion: Aspects of quality EOL care important to stakeholders may not be measurable from administrative data. Results from the Delphi panels indicate that patient preferences and differences in health care delivery between different jurisdictions modulated extent of agreement with QIs. No significant financial relationships to disclose.

Quality indicators for end-of-life breast cancer care: Testing the use of administrative databases

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6066-6066 ◽  
Author(s):  
L. Lethbridge ◽  
E. Grunfeld ◽  
R. Dewar ◽  
G. Johnston ◽  
P. McIntyre ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
End Of Life ◽  
Administrative Data ◽  
Population Based ◽  
Vital Statistics ◽  
Administrative Databases ◽  
Breast Cancer Patients ◽  
Eol Care

6066 Background: Defining, measuring and monitoring quality of care is a facet of health services research that is growing in importance. Breast cancer offers a disease model to examine quality end-of-life (EOL) care provided to women. Administrative data have the unique potential to provide population-based measures of quality of care. The objective of this study was to assess the feasibility of using routinely-collected administrative data to measure quality EOL care for breast cancer patients. Methods: A cohort of all women in Nova Scotia who died of breast cancer between 01/01/1998 and 31/12/2002 was assembled from the Cancer Registry and Vital Statistics data. The EOL study period was defined as the last 6 months of life. A total of 864 women met the eligibility criteria. After a literature review, an expert panel identified 19 indicators that were potentially measurable through administrative data. Physician billings, hospital discharge abstracts and seniors pharmacare data, supplemented by clinical datasets, were utilized to calculate the statistics with which to represent the indicators. Results: Benchmark measures of care across the cohort show 63.4% died in a hospital, a mean continuity of care index of 0.786, and the mean number of inpatient days in the last 30 was 9.9. Indicators of aggressive care include 9.3% had chemotherapy in the last 14 days, 5.6% had more than 1 emergency room visit in the last 30 days, and 29.1% had more than 14 inpatient days in the last 30 days. Conclusions: Weaknesses of using these data include: 1) fixed variables with an administrative rather than a clinical objective; 2) lack of comprehensiveness of various datasets; and 3) the use of billings data where increasingly physicians are paid through methods other than fee-for-service. Strengths of this approach are: 1) population-based cohort; 2) comprehensiveness of cohort selection through the provincial Vital Statistics file; and 3) accessibility of data. No significant financial relationships to disclose.

Identifying Potential Indicators of the Quality of End-of-Life Cancer Care From Administrative Data

2003 ◽  
Vol 21 (6) ◽  
pp. 1133-1138 ◽  
Author(s):  
Craig C. Earle ◽  
Elyse R. Park ◽  
Bonnie Lai ◽  
Jane C. Weeks ◽  
John Z. Ayanian ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Quality Indicators ◽  
Administrative Data ◽  
Cancer Care ◽  
Symptom Control ◽  
Family Members ◽  
Data Systems ◽  
Delphi Approach

Purpose: To explore potential indicators of the quality of end-of-life services for cancer patients that could be monitored using existing administrative data. Methods: Quality indicators were identified and assessed by literature review for proposed indicators, focus groups with cancer patients and family members to assess candidate indicators and generate new ideas, and an expert panel ranking the meaningfulness and importance of each potential indicator using a modified Delphi approach. Results: There were three major concepts of poor quality of end-of-life cancer care that could be examined using currently-available administrative data (such as Medicare claims): institution of new anticancer therapies or continuation of ongoing treatments very near death; a high number of emergency room visits, inpatient hospital admissions, or intensive care unit days near the end of life; and a high proportion of patients never enrolled in hospice, only admitted in the last few days of life, or dying in an acute-care setting. Concepts such as access to psychosocial and other multidisciplinary services and pain and symptom control are important and may eventually be feasible, but they cannot currently be applied in most data systems. Indicators based on limiting the use of treatments with low probability of benefit or indicators based on economic efficiency were not acceptable to patients, family members, or physicians. Conclusion: Several promising claims-based quality indicators were identified that, if found to be valid and reliable within data systems, could be useful in identifying health-care systems in need of improving end-of-life services.

Quality Indicators of End-of-Life Care in Patients With Cancer: What Rate Is Right?

2015 ◽  
Vol 11 (3) ◽  
pp. e279-e287 ◽  
Author(s):  
Lisa Barbera ◽  
Hsien Seow ◽  
Rinku Sutradhar ◽  
Anna Chu ◽  
Fred Burge ◽  
...  
Keyword(s):  
Quality Improvement ◽  
End Of Life ◽  
Quality Indicators ◽  
End Of Life Care ◽  
Significant Variation ◽  
Life Quality ◽  
Life Care ◽  
Patients With Cancer

There is significant variation in end-of-life quality indicators across regions in four provinces in Canada. Applying this study's methods can support quality improvement by decreasing variation and striving for a target.

scholarly journals A descriptive analysis of end-of-life discussions for high-grade glioma patients

2021 ◽  
Author(s):  
Ai Chikada ◽  
Sayaka Takenouchi ◽  
Yoshiki Arakawa ◽  
Kazuko Nin
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
Patient Participation ◽  
High Grade Glioma ◽  
Team Approach ◽  
High Grade ◽  
Care Providers ◽  
Patient Goals ◽  
Significant Difference ◽  
Eol Care

Abstract Background End-of-life discussions (EOLDs) in patients with high-grade glioma (HGG) have not been well described. Therefore, this study examined the appropriateness of timing and the extent of patient involvement in EOLDs and their impact on HGG patients. Methods A cross-sectional survey was conducted among 105 bereaved families of HGG patients at a university hospital in Japan between July and August 2019. Fisher’s exact test and the Wilcoxon rank-sum test were used to assess the association between patient participation in EOLDs and their outcomes. Results In total, 77 questionnaires were returned (response rate 73%), of which 20 respondents replied with refusal documents. Overall, 31/57 (54%) participated in EOLDs at least once in acute hospital settings, and a significant difference was observed between participating and nonparticipating groups in communicating the patient’s wishes for EOL care to the family (48% vs 8%, P = .001). Moreover, >80% of respondents indicated that the initiation of EOLDs during the early diagnosis period with patients and families was appropriate. Most EOLDs were provided by neurosurgeons (96%), and other health care providers rarely participated. Additionally, patient goals and priorities were discussed in only 28% of the EOLDs. Patient participation in EOLDs was not associated with the quality of EOL care and a good death. Conclusions Although participation in EOLDs is relatively challenging for HGG patients, this study showed that participation in EOLDs may enable patients to express their wishes regarding EOL care. It is important to initiate EOLDs early on through an interdisciplinary team approach while respecting patient goals and priorities.

scholarly journals End of life breast cancer care in women with severe mental illnesses

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Guillaume Fond ◽  
Vanessa Pauly ◽  
Audrey Duba ◽  
Sebastien Salas ◽  
Marie Viprey ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Palliative Care ◽  
Health Disparities ◽  
Major Depression ◽  
End Of Life ◽  
High Intensity ◽  
Bipolar Disorders ◽  
Mental Illnesses ◽  
Targeted Interventions ◽  
Eol Care

AbstractLittle is known on the end-of-life (EOL) care of terminal breast cancer in women with severe psychiatric disorder (SPD). The objective was to determine if women with SPD and terminal breast cancer received the same palliative and high-intensity care during their end-of-life than women without SPD. Study design, setting, participants. This population-based cohort study included all women aged 15 and older who died from breast cancer in hospitals in France (2014–2018). Key measurements/outcomes. Indicators of palliative care and high-intensity EOL care. Multivariable models were performed, adjusted for age at death, year of death, social deprivation, duration between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 1742 women with SPD (287 with bipolar disorder, 1075 with major depression and 380 with schizophrenia) and 36,870 women without SPD. In multivariate analyses, women with SPD had more palliative care (adjusted odd ratio aOR 1.320, 95%CI [1.153–1.511], p < 0.001), longer palliative care follow-up before death (adjusted beta = 1.456, 95%CI (1.357–1.555), p < 0.001), less chemotherapy, surgery, imaging/endoscopy, and admission in emergency department and intensive care unit. Among women with SPD, women with bipolar disorders and schizophrenia died 5 years younger than those with recurrent major depression. The survival time was also shortened in women with schizophrenia. Despite more palliative care and less high-intensity care in women with SPD, our findings also suggest the existence of health disparities in women with bipolar disorders and schizophrenia compared to women with recurrent major depression and without SPD. Targeted interventions may be needed for women with bipolar disorders and schizophrenia to prevent these health disparities.

scholarly journals Discussions Between People With Dementia and Care Partners About End-of-Life Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 162-162
Author(s):  
Megan Shepherd-Banigan ◽  
Cassie Ford ◽  
Emmanuelle Belanger ◽  
Courtney Van Houtven
Keyword(s):  
End Of Life ◽  
Linear Models ◽  
Positive Association ◽  
Living Will ◽  
Amyloid Pet ◽  
Care Planning ◽  
Care Plans ◽  
People With Dementia ◽  
Care Partners ◽  
Eol Care

Abstract Advanced care planning (ACP) leads to better end-of-life (EoL) care. Yet, some care-partners are unaware of the person with dementia’s (PwD) preferences. Care-partners play an important role in urging PwD to consider their EoL care wishes early in their disease course and to document those wishes. However, it is unknown whether discussions between care-partners and PwD are associated with documenting EoL care plans. We apply generalized linear models to baseline data from the CARE-IDEAS study which includes a sample of patients who received an amyloid PET scan and their care-partners (n=1,672). We examine the association between PwD report of having discussed EoL care with their care-partner and PwD report of having documented their plans through an advanced directive, a living will, or designating a health care proxy. PwD who reported speaking with their care-partners about EoL care were 10% (marginal probability (MP) 0.10; 95% CI: 0.8, 0.13) more likely to have documented their EoL care wishes. Furthermore, if PwD and care-partners agreed that they had discussed EoL care, PwD were 7% (MP 0.7; 95% CI 0.04, 0.10) more likely to report that they documented their EoL care plans. The positive association between communicating with care-partners about EoL care and having formal EoL care plans suggests that the ACP process could be a systematic approach to increase the care-partner’s knowledge of PwD EoL wishes. These results also suggest that increasing involvement of care partners in ACP may encourage patients to document their wishes at end of life.

“We Are All Humans and Deserve a Decent Way to Go”: Examining Professional’s Experiences With Providing End-of-Life Care in Correctional Institutions

2021 ◽  
pp. 073401682110208
Author(s):  
Mollee Steely Smith ◽  
Brooke Cooley ◽  
Tusty ten Bensel
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Service Providers ◽  
Prison Population ◽  
Correctional Institutions ◽  
Southern State ◽  
Face To Face ◽  
The Past ◽  
Eol Care ◽  
Emotional Effects

The aging prison population has increased dramatically over the past two decades. As this population increases, correctional institutions are faced with health care challenges. Specifically, providing adequate end-of-life (EOL) care for terminally ill inmates has been a concern. Despite issues relating to providing EOL care, little is known about medical and correctional staff’s attitudes toward the implementation of EOL care. The purpose of this study was to understand the challenges faced by correctional and medical professionals, focusing on job satisfaction, obstacles, and emotional effects of providing EOL care in correctional institutions. Our data included 17 semistructured, face-to-face interviews with medical and correctional staff assigned to the EOL care unit in a southern state. Although the entire sample stated overall satisfaction with their job, participants noted several challenges and stressors, which included the lack of resources and difficulties in balancing care. Participants agreed that it was emotionally stressful to maintain appropriate relationships with the inmates, deal with patient manipulation, and be surrounded by dying and death. Implications are discussed relative to the needs and experiences of service providers and how to more effectively treat EOL inmate patients.

Cannabis and End-of-Life Care: A Snapshot of Hospice Planning and Experiences Among Illinois Medical Cannabis Patients With A Terminal Diagnosis

2021 ◽  
pp. 104990912110186
Author(s):  
James Alton Croker ◽  
Julie Bobitt ◽  
Sara Sanders ◽  
Kanika Arora ◽  
Keith Mueller ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Fast Track ◽  
Hospice Care ◽  
Cannabis Use ◽  
Care Plan ◽  
Medical Cannabis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Eol Care

Introduction: Between 2013 and 2019, Illinois limited cannabis access to certified patients enrolled in the Illinois Medical Cannabis Program (IMCP). In 2016, the state instituted a fast-track pathway for terminal patients. The benefits of medicinal cannabis (MC) have clear implications for patients near end-of-life (EOL). However, little is known about how terminal patients engage medical cannabis relative to supportive care. Methods: Anonymous cross-sectional survey data were collected from 342 terminal patients who were already enrolled in ( n = 19) or planning to enroll ( n = 323) in hospice for EOL care. Logistic regression models compare patients in the sample on hospice planning vs. hospice enrollment, use of palliative care vs. hospice care, and use standard care vs non-hospice palliative care. Results: In our sample, cancer patients ( OR = 0.21 (0.11), p < .01), and those who used the fast-track application into the IMCP ( OR = 0.11 (0.06), p < .001) were less likely to be enrolled in hospice. Compared to patients in palliative care, hospice patients were less likely to report cancer as their qualifying condition ( OR = 0.16 (0.11), p < .01), or entered the IMCP via the fast-track ( OR = 0.23 (0.15), p < .05). Discussion: Given low hospice enrollment in a fairly large EOL sample, cannabis use may operate as an alternative to supportive forms of care like hospice and palliation. Clinicians should initiate conversations about cannabis use with their patients while also engaging EOL Care planning discussions as an essential part of the general care plan.

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