Quality indicators in palliative care day services

Abstract

Background: Quality indicators can be used to monitor quality of care, compare health settings and support patient choice. They allow us to see how healthcare professionals and services function to provide for the needs of patients and carers. The main aim of this project is to produce a list of quality indicators for evaluating care in palliative care day services (PCDS). Methods: We used a modified Delphi technique to generate candidate quality indicators through a process of expert consensus and evidence appraisal. Using the RAND/UCLA Appropriateness Method, these experts rated the appropriateness of potential quality indicators using their own experience and knowledge, as well as evidence summary tables based on a literature review. Expert panel members also identified indicators not on the original list. A panel meeting was held at which the indicators were discussed and re-rated (on appropriateness and necessity). Findings: The initial list of 185 quality indicators, identified in the literature review was reduced to 55 after the two rounds of panel ratings. This was subsequently reduced to 25 indicators by the project team, in an attempt to consolidate the indicators chosen by the expert panel. Discussion: The final list of quality indicators are the first to be produced for PCDS, and highlight elements of structure, process and outcome (including psychological issues), which are important in any good quality PCDS. Despite the variation in the content of PCDS across the UK, the set of quality indicators are sufficiently flexible to apply to a range of PCDS.