Quality indicators for palliative care in intensive care units: a systematic review

Abstract

Background: Establishing appropriate quality assessment indicators for palliative care in intensive care units (ICUs) is vital. This systematic review summarizes the existing quality indicators (QIs) for palliative care in ICUs. It assesses the methodological quality of QI development to pave the way for more valid QIs. Methods: A literature search was conducted using MEDLINE, PsycINFO, CINAHL, Cochrane databases, and the Ichushi-web database for Japanese literature for all studies published until November 2021. The included QIs were drawn from the National Consensus Project for Quality Palliative Care (NCP) and the Donabedian model of quality. Methodological quality was assessed based on the appraisal of indicators through the research and evaluation tool.Results: Five studies were included, from which 109 indicators were extracted: 78% were process indicators, 5% were outcome indicators, and 17% were structure indicators. The most common indicators addressed the palliative care domain of "ethical and legal aspects of care" (n=38, 30%). Another distinctive feature of some indicators was a focus on supporting ICU staff. Regarding methodological quality, the "scientific evidence" varied (11-89%). Most of the data on QI measures and data sources were obtained from a review of electronic medical records (EMRs). Administrative data also provided a few measurable indicators.Conclusions: Out of all the QIs covered in this review, most were process indicators, and only a few were outcome indicators. Ethical and legal aspects of care and support for the ICU staff emerged as unique to palliative care. Although the existing QIs can be used for palliative care in ICUs, more specific indicators are urgently needed. Continuous quality assessment and improvement, as well as the addition of more palliative care practices in ICUs, would provide further evidence and help develop valid QIs.

Key performance indicators for pharmaceutical services: A systematic review

“…27 Prior systematic reviews of quality indicators use the same instrument. 28 , 29 , 30 , 31 The AIRE instrument consists of four domains (1. purpose, relevance, and organizational context, 2. stakeholder involvement, 3. scientific evidence, and 4. additional evidence, formulation, and usage) subdivided into 20 items which are listed in Supplementary Data S2. Each item is scored on a 4-point Likert scale (1 = strongly disagree or no information provided, 2 = disagree, 3 = agree, 4 = strongly agree).…”

Development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review

“…In round 1, a systematic review of the QIs of palliative care in ICUs was conducted [ 26 ], and focus group interviews were held with eight core study members (palliative care physicians, intensivists, emergency physicians, nurses, and an expert on Delphi methodology).…”

“…Most of them focus on process indicators and do not include all three aforementioned aspects. Second, their feasibility has not been tested during development [ 26 ]. Additionally, they are based on a consensus among project teams in the United States [ 26 ] and have not been considered for use in other countries, such as those in Asia.…”

“…Second, their feasibility has not been tested during development [ 26 ]. Additionally, they are based on a consensus among project teams in the United States [ 26 ] and have not been considered for use in other countries, such as those in Asia. Since the roles and functions of ICUs vary according to the healthcare delivery system and culture of each country, it is imperative to develop QI sets for individual countries [ 27 ].…”

Enhancing palliative care for patients hospitalized in the intensive care unit and their families: Challenges & strategies

“…This includes developing standardized screening tools and training healthcare providers to recognize signs of distress, uncontrolled symptoms, or deteriorating prognosis. By identifying these patients early, we can initiate palliative care interventions promptly, ensuring that their needs are addressed throughout their ICU stay [6,7].…”