Quality indicators for the evaluation of end-of-life care in Germany – a retrospective cross-sectional analysis of statutory health insurance data

Abstract

Background The provision and quality of end-of-life care (EoLC) in Germany is inconsistent. Therefore, an evaluation of current EoLC based on quality indicators is needed. This study aims to evaluate EoLC in Germany on the basis of quality indicators pertaining to curative overtreatment, palliative undertreatment and delayed palliative care (PC). Results were compared with previous findings. Methods Data from a statutory health insurance provider (AOK Lower Saxony) pertaining to deceased members in the years 2016 and 2017 were used to evaluate EoLC. The main indicators were: chemotherapy for cancer patients in the last month of life, first-time percutaneous endoscopic gastrostomy (PEG) for patients with dementia in the last 3 months of life, number of hospitalisations and days spent in inpatient treatment in the last 6 months of life, and provision of generalist and specialist outpatient PC in the last year of life. Data were analysed descriptively. Results Data for 64,275 deceased members (54.3% female; 35.1% cancer patients) were analysed. With respect to curative overtreatment, 10.4% of the deceased with cancer underwent chemotherapy in the last month and 0.9% with dementia had a new PEG insertion in the last 3 months of life. The mean number of hospitalisations and inpatient treatment days per deceased member was 1.6 and 16.5, respectively, in the last 6 months of life. Concerning palliative undertreatment, generalist outpatient PC was provided for 28.0% and specialist outpatient PC was provided for 9.0% of the deceased. Regarding indicators for delayed PC, the median onset of generalist and specialist outpatient PC was 47.0 and 24.0 days before death, respectively. Conclusion Compared to data from 2010 to 2014, the data analysed in the present study suggest an ongoing curative overtreatment in terms of chemotherapy and hospitalisation, a reduction in new PEG insertions and an increase in specialist PC. The number of patients receiving generalist PC remained low, with delayed onset. Greater awareness of generalist PC and the early integration of PC are recommended. Trial registration The study was registered in the German Clinical Trials Register (DRKS00015108; 22 January 2019).

The frequency and time point of outpatient palliative care integration for people before death: an analysis of health insurance data in Lower Saxony, Germany

“…According to the data, 31.4% of the insured persons who died in 2017 received outpatient palliative care during the course of their illness; this figure is significantly below the estimated demand of up to 80% (Scholten et al 2016). Although this demand figure does not exclusively refer to outpatient services, which was the sole consideration of our data, the results nonetheless provide a clear indication of an undersupply of outpatient palliative care (Soziale Pflegeversicherung 2021; Ditscheid et al 2020;van Baal et al 2020).…”

Quality indicators of palliative care for cardiovascular intensive care

“…According to the claim data, the proposed appropriate threshold for proportion receiving chemotherapy in the last 14 days of life and admission to the ICU in the last month of life were 10% and 4%, respectively [ 37 ]. Palliative care utilization and site of death have also been frequently discussed especially based on the whether the medical care was consistent with the patient’s needs [ 38 , 39 ]. Not only would the indicators themselves but also the strategy and frameworks to make quality indicators be useful for many non-cancer field healthcare providers, especially in CICUs, to understand the current concepts and methods of palliative care.…”

Quality Of End-Of-Life Care In General Practice – A Pre–Post Comparison Of A Two-Tiered Intervention

“…In Germany, specialist outpatient PC has increased in recent years, while the provision of generalist outpatient PC is rare and declining [11,12]. In addition, generalist outpatient PC tends to be provided relatively late in the care trajectory [11]. The early identi cation of patients with PC needs is particularly challenging for GPs in daily practice due to, among other reasons, prognostic uncertainty [13][14][15].…”

“…Quality indicators are regularly applied to measure the quality of EoLC [7][8][9][10]. In Germany, specialist outpatient PC has increased in recent years, while the provision of generalist outpatient PC is rare and declining [11,12]. In addition, generalist outpatient PC tends to be provided relatively late in the care trajectory [11].…”