title: Palliative care quality indicators in Italy. What do we evaluate?
abstract: OBJECTIVE
  In recent years, the number of palliative service providers has increased significantly. This expansion necessitates an evaluation in order to provide the basis for quality improvement of the care. Policymakers, managers of palliative care programs, and others committed to the improvement of end-of-life care need methods and criteria to measure and evaluate the care delivered. As quality measurement is expensive and difficult to undertake, it is fundamental that quality measures evaluate the right things. Quality evaluation in Italy is supported by health authorities who have developed some indicators of palliative care. The aims of this study were to give an overview of these indicators.
  
  
  METHODS
  We analyzed all palliative care indicators developed by Italian national authorities from 2000 to the present. These indicators have been divided into three different levels of analysis (structure, process, and outcome). Subsequently, two reviewers have independently compared their degree of concordance with domains, and guidelines developed by the NCP for palliative care and after careful discussion an expert panel has elaborated a final consensus document.
  
  
  RESULTS
  Most of the quality indicators analyzed deal with the structure and process of palliative care, however they miss outcomes and do not cover domains mainly concerned with spiritual, ethical, cultural, or existential aspects of care.
  
  
  CONCLUSIONS
  More attention should be paid to the development of outcome indicators of palliative care. The attempt to identify a group of indicators which cover every domain of palliative care represents a challenge for the future in terms of finding new cognitive models more oriented toward subjectivity.
authors: School of Nursing, University Tor Vergata, Rome, Italy. d.angelo@med.uniroma2.it
authors: Daniela
authors: D
authors: D'Angelo
authors: Chiara
authors: C
authors: Mastroianni
authors: Ercole
authors: E
authors: Vellone
authors: Rosaria
authors: R
authors: Alvaro
authors: Giuseppe
authors: G
authors: Casale
authors: Roberto
authors: R
authors: Latina
authors: Maria Grazia
authors: MG
authors: De Marinis
mesh_terms: D006801:Humans; D007558:Italy; D010166:Palliative Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D013727:Terminal Care