Appropriateness of end-of-life care in people dying from COPD : applying quality indicators on linked administrative databases

Article

DE SCHREYE, Robrecht | SMETS, Tinne | DELIENS, Luc | ANNEMANS, Lieven | GIELEN, Birgit | COHEN, Joachim

INTRODUCTION: Large-scale evaluations of the quality of end-of-life care in people with COPD are lacking. By means of a validated set of quality indicators, this study aims 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 (ICD10 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: 4,231 people died from COPD. During the last 30 days of life, 60% was admitted to hospital, 11.8% received specialized palliative care. Large regional variation was found in specialized palliative care use (4.0% to 32.0%) and diagnostic testing in the last 30 days of life (44.0% to 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.

http://dx.doi.org/10.1016/j.jpainsymman.2018.06.011

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