Appropriateness of End-of-Life Care in People Dying From COPD. Applying Quality Indicators on Linked Administrative Databases.

Abstract

CONTEXT:

Large-scale evaluations of the quality of end-of-life care in people with chronic obstructive pulmonary disease (COPD) are lacking.

OBJECTIVES:

By means of a validated set of quality indicators (QIs), this study aimed to 1) assess appropriateness of end-of-life care in people dying from COPD; 2) examine variation between care regions; 3) establish performance standards.

METHODS:

We conducted a retrospective observational study of all deaths from COPD (ICD-10 codes J41-J44) in 2012 in Belgium, using data from administrative population-level databases. QI scores were risk-adjusted for comparison between care regions.

RESULTS:

A total of 4231 people died from COPD. During the last 30 days of life, 60% was admitted to hospital and 11.8% received specialized palliative care. Large regional variation was found in specialized palliative care use (4.0%-32.0%) and diagnostic testing in the last 30 days of life (44.0%-69.7%). Based on best performing quartile scores, relative standards were set (e.g., ≤54.9% for diagnostic testing).

CONCLUSION:

Our study found indications of inappropriate end-of-life care in people with COPD, such as high percentages of diagnostic testing and hospital admissions and low proportions receiving specialized palliative care. Risk-adjusted variation between regions was high for several QIs, indicating the usefulness of relative performance standards to improve quality of end-of-life COPD care.

• Authors: Robrecht De Schreye, Tinne Smets, Luc Deliens, Lieven Annemans, Birgit Gielen, Joachim Cohen
• Journal: Journal of pain and symptom management (J Pain Symptom Manage) Vol. 56 Issue 4 Pg. 541-550.e6 (10 2018) ISSN: 1873-6513 [Electronic] United States
• PMID: 29960021 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Belgium
• Databases, Factual
• Female
• Humans
• Male
• Middle Aged
• Palliative Care (standards)
• Pulmonary Disease, Chronic Obstructive (mortality, therapy)
• Quality of Health Care
• Retrospective Studies
• Risk
• Terminal Care (standards)
• Young Adult