title: Validation of quality indicators for the organization of palliative care: a modified RAND Delphi study in seven European countries (the Europall project).
abstract: BACKGROUND
  Validated quality indicators can help health-care professionals to evaluate their medical practices in a comparative manner to deliver optimal clinical care. No international set of quality indicators to measure the organizational aspects of palliative care settings exists.
  
  
  OBJECTIVE
  To develop and validate a set of structure and process indicators for palliative care settings in Europe.
  
  
  METHODS
  A two-round modified RAND Delphi process was conducted to rate clarity and usefulness of a previously developed set of 110 quality indicators.
  
  
  METHODS
  In total, 20 multi-professional palliative care teams of centers of excellence from seven European countries.
  
  
  RESULTS
  In total, 56 quality indicators were rated as useful. These valid quality indicators concerned the following domains: the definition of a palliative care service (2 quality indicators), accessibility to palliative care (16 quality indicators), specific infrastructure to deliver palliative care (8 quality indicators), symptom assessment tools (1 quality indicator), specific personnel in palliative care services (9 quality indicators), documentation methodology of clinical data (14 quality indicators), evaluation of quality and safety procedures (1 quality indicator), reporting of clinical activities (1 quality indicator), and education in palliative care (4 quality indicator).
  
  
  CONCLUSIONS
  The modified RAND Delphi process resulted in 56 international face-validated quality indicators to measure and compare organizational aspects of palliative care. These quality indicators, aimed to assess and improve the organization of palliative care, will be pilot tested in palliative care settings all over Europe and be used in the EU FP7 funded IMPACT project.
authors.affiliation: 1Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Woitha
authors.forename: Karen
authors.initials: K
authors.lastname: Van Beek
authors.forename: Nisar
authors.initials: N
authors.lastname: Ahmed
authors.forename: Birgit
authors.initials: B
authors.lastname: Jaspers
authors.forename: Jean M
authors.initials: JM
authors.lastname: Mollard
authors.forename: Sam H
authors.initials: SH
authors.lastname: Ahmedzai
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hasselaar
authors.forename: Johan
authors.initials: J
authors.lastname: Menten
authors.forename: Kris
authors.initials: K
authors.lastname: Vissers
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Engels
mesh_terms: D003697:Delphi Technique; D004282:Documentation; D004493:Education; D005060:Europe / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D010166:Palliative Care / Q000379:methods / Q000458:organization & administration* / Q000592:standards*; D010348:Patient Care Team; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards; D012449:Safety; D063189:Symptom Assessment / Q000295:instrumentation
keywords: Europe; Palliative care; RAND Delphi; quality indicators; structure and process