title: Registration in a quality register: a method to improve end-of-life care--a cross-sectional study.
abstract: OBJECTIVE
  Structured methods to assess and support improvement in the quality of end-of-life care are lacking and need to be developed. This need is particularly high outside the specialised palliative care. This study examines whether participation in a national quality register increased the quality of end-of-life care.
  
  
  METHODS
  This study is a cross-sectional longitudinal register study.
  
  
  METHODS
  The Swedish Register of Palliative Care (SRPC) collects data about end-of-life care for deaths in all types of healthcare units all over Sweden. Data from all 503 healthcare units that had reported patients continuously to the register during a 3-year period were analysed.
  
  
  METHODS
  Data on provided care during the last weeks of life were compared year-by-year with logistic regression.
  
  
  METHODS
  The study included a total 30 283 patients. The gender distribution was 54% women and 46% men. A total of 60% of patients in the study had a cancer diagnosis.
  
  
  RESULTS
  Provided end-of-life care improved in a number of ways. The prevalence of six examined symptoms decreased. The prescription of 'as needed' medications for pain, nausea, anxiety and death rattle increased. A higher proportion of patients died in their place of preference. The patient's next of kin was more often offered a follow-up appointment after the patient's death. No changes were seen with respect to providing information to the patient or next of kin.
  
  
  CONCLUSIONS
  Participation in a national quality register covariates with quality improvements in end-of-life care over time.
authors.affiliation: Department of Radiation Sciences, Umeå University, Umeå, Sweden.
authors.forename: Lisa
authors.initials: L
authors.lastname: Martinsson
authors.forename: Carl Johan
authors.initials: CJ
authors.lastname: Fürst
authors.forename: Staffan
authors.initials: S
authors.lastname: Lundström
authors.forename: Lena
authors.initials: L
authors.lastname: Nathanaelsson
authors.forename: Bertil
authors.initials: B
authors.lastname: Axelsson