title: Variations in process and outcome in inpatient palliative care services in Korea.
abstract: OBJECTIVE
  Hospice programs in Korea have been largely based on volunteer activity, religious services, or social services. Recent government policy of designating medically based inpatient palliative care services and per diem payment system made it necessary to monitor the quality of these services. We examined the variation in the process and outcomes of palliative care services, using 2009 data obtained from the Korean Terminal Cancer Patient Information System.
  
  
  METHODS
  Data were collected from 3,867 patients with terminal cancer who were registered in 34 inpatient palliative care centers designated by the Ministry of Health and Welfare. We used the mean length of stay and the subsequent place of care as process indicators, and change in average pain score as an outcome indicator. The data were analyzed using descriptive statistics, and analysis of covariance for the case-mix adjustment.
  
  
  RESULTS
  There were considerable variations among services with regards to the mean length of stay (i.e., 10.5 to 32.6 days for each admission) and subsequent place of care (i.e., 39.8% to 92.6% ended in death at the first admission), even after stratification by service level. The mean change in average pain score varied from -1.48 to 2.16, and remained significant after case-mix adjustment.
  
  
  CONCLUSIONS
  We found considerable variations among palliative care services with regard to the mean length of stay, subsequent place of care, and change in average pain score. Continued assessment of the variations in process and outcomes will assist in developing the national benchmarking system and the evaluation of the government policy.
authors.affiliation: National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi, South Korea.
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Shin
authors.forename: Jina
authors.initials: J
authors.lastname: Kang
authors.forename: Young Ji
authors.initials: YJ
authors.lastname: Baek
authors.forename: Ha Na
authors.initials: HN
authors.lastname: Mo
authors.forename: Byung-Ho
authors.initials: BH
authors.lastname: Nam
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Seo
authors.forename: Jong Hyock
authors.initials: JH
authors.lastname: Park
authors.forename: Jung Hoe
authors.initials: JH
authors.lastname: Kim
authors.forename: Kee Taig
authors.initials: KT
authors.lastname: Jung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007723:Korea; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010146:Pain / Q000453:epidemiology; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D058996:Quality Improvement / Q000458:organization & administration; D056910:Republic of Korea; D015996:Survival Rate; D013727:Terminal Care / Q000379:methods / Q000706:statistics & numerical data; D055815:Young Adult