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

Abstract

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.

Healthcare utilization at the end of life in people dying from amyotrophic lateral sclerosis: A retrospective cohort study using linked administrative data

“…Two previous studies using similar quality indicators allow for comparison with people who died from cancer or COPD. Our findings show that considerably more people who died from ALS received specialized palliative care (43.8%) those who died from COPD (12%) [25], and about the same proportion of people who died from cancer (47%) [26]. Patients who died from ALS more often died at home (39.4%) than those who died from cancer (29.5%) or COPD (28.2%), and on average they had more contacts with a primary caregiver (mean number of 3.2 contacts in the last week of life versus 1.1 for COPD and 2.4 for cancer).…”

“…Compared to people who died from COPD and cancer, people who died from ALS had similar rates of hospital and ICU admissions at the end of life. The rates of ED admissions among ALS patients were lower at one month before death (31.3% versus 33.8% (cancer) and 40.5% (COPD)), but higher in the last week of life (18.9% versus 12.9% (cancer) and 16.1% (COPD)) [25,26], a pattern that was also found in a retrospective cross-sectional study from Australia that compared hospital and emergency department use in the last year of life between people dying from cancer and people dying from other conditions where death was expected [27]. This might indicate that patients and caregivers are potentially less prepared to handle crisis situations at the end of life in ALS, compared to end of life situations in other serious illnesses.…”

Evaluación de la calidad de los servicios de cuidados paliativos domiciliarios: revisión de la literatura

“…Tam bién se encuentran mediciones del im pacto del proceso de enfer medad en el cuidador, y la presencia y el manejo de sínto mas. Los indicadores q ue evalúan las preferencias para el fallecimiento (lugar, m o mento) son parecidos a los presentados por De Schreye et ál., q uienes reportan q ue la proporción de pacientes q ue fallecen en casa varía entre países europeos, siendo Países Bajos el q ue reporta mayor porcentaje (15). Nakazawa et ál.…”

“…Durante la revisión se encontró q ue los 9 indicadores de estr uctura se miden con preguntas cerradas con opciones de respuesta negativa o afir mativa. En los dos artículos q ue contem plan este tipo de indicadores (15,16) Evaluación de la calidad de los servicios de cuidados paliativos domiciliarios: revisión de la literatura | Yahel-Tatiana Mejía-R., Amine-Yulie Carlier-S. Claudia-Marcela Vargas-M., Karen-Johanna López-P., Genny-Paola Fuentes-B. e025 se plantean indicadores relacionados con la existencia de personal calificado para la atención en cuidados paliativos y evalúan la interdisciplinariedad, así co m o la for mación y capacitación continua del personal; sin em bargo, en ninguno de ellos se plantea la relación entre la cantidad del recurso humano, ya sea personal médico o de enfer mería, y el número de pacientes atendidos.…”

Promoting Primary Palliative Care in Severe Chronic Obstructive Pulmonary Disease: Symptom Management and Preparedness Planning

“…Proactive involvement of palliative care in severe COPD has had a positive impact, 6,7 yet appropriate access to palliative care is lacking for a significant majority of people with severe COPD. 8,9 With the shortage of specialty palliative care clinicians, it is important that all providers possess skills in basic primary palliative care: managing pain and other symptoms and initiating conversations about values, preferences, and goals of care in uncomplicated cases. 10 Improving access to palliative care in severe COPD has the potential to impact the quality of life and disease trajectory of patients.…”