title: Palliative care at the end of life: comparing quality in diverse settings.
abstract: There is growing awareness that pain and other symptoms are often poorly managed at the end of life. The purpose of this quality improvement project was to compare the quality of care provided to a convenience sample of 195 patients who died during a six-month period, using a retrospective chart review. Quality was defined by symptom documentation, use of diagnostic and therapeutic procedures in the final 48 hours of life, and determination of advance directives. Daily and total charges incurred by these patients were also captured. Symptom distress was common, and diagnostic and therapeutic procedures were widespread. These data suggest areas for improvement in clinical practice, in palliative care units, and in all settings where end-of-life care is provided. Also, the data can guide future research into the quality of care provided to dying persons.
authors.affiliation: Northwestern University Medical School, Division of Hematology-Oncology, Northwestern Memorial Hospital, Palliative Care and Home Hospice Program, Chicago, Illinois, USA.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Paice
authors.forename: J Cameron
authors.initials: JC
authors.lastname: Muir
authors.forename: Susan
authors.initials: S
authors.lastname: Shott
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000706:statistics & numerical data; D001601:Bereavement; D005249:Fees and Charges / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States; D010043:Outcome and Process Assessment, Health Care; D010166:Palliative Care / Q000145:classification / Q000191:economics / Q000706:statistics & numerical data*; D011368:Professional-Family Relations; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care / Q000145:classification / Q000191:economics / Q000706:statistics & numerical data*