title: Using the medical record to evaluate the quality of end-of-life care in the intensive care unit.
abstract: BACKGROUND
  We investigated whether proposed "quality markers" within the medical record are associated with family assessment of the quality of dying and death in the intensive care unit (ICU).
  
  
  OBJECTIVE
  To identify chart-based markers that could be used as measures for improving the quality of end-of-life care.
  
  
  METHODS
  A multicenter study conducting standardized chart abstraction and surveying families of patients who died in the ICU or within 24 hrs of being transferred from an ICU.
  
  
  METHODS
  ICUs at ten hospitals in the northwest United States.
  
  
  METHODS
  Overall, 356 patients who died in the ICU or within 24 hrs of transfer from an ICU.
  
  
  METHODS
  The 22-item family assessed Quality of Dying and Death (QODD-22) questionnaire and a single item rating of the overall quality of dying and death (QODD-1).
  
  
  METHODS
  The associations of chart-based quality markers with QODD scores were tested using Mann-Whitney U tests, Kruskal-Wallis tests, or Spearman's rank-correlation coefficients as appropriate.
  
  
  RESULTS
  Higher QODD-22 scores were associated with documentation of a living will (p = .03), absence of cardiopulmonary resuscitation performed in the last hour of life (p = .01), withdrawal of tube feeding (p = .04), family presence at time of death (p = .02), and discussion of the patient's wish to withdraw life support during a family conference (p < .001). Additional correlates with a higher QODD-1 score included use of standardized comfort care orders and occurrence of a family conference (p < or = .05).
  
  
  CONCLUSIONS
  We identified chart-based variables associated with higher QODD scores. These QODD scores could serve as targets for measuring and improving the quality of end-of-life care in the ICU.
authors: Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Washington, Seattle, WA, USA. bglavan@u.washington.edu
authors: Bradford J
authors: BJ
authors: Glavan
authors: Ruth A
authors: RA
authors: Engelberg
authors: Lois
authors: L
authors: Downey
authors: J Randall
authors: JR
authors: Curtis
mesh_terms: D001293:Attitude to Death; D003422:Critical Care / Q000145:classification*; D005190:Family / Q000523:psychology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008499:Medical Records; D010166:Palliative Care / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000379:methods*; D011795:Surveys and Questionnaires