title: Testing feasibility and reliability of a set of quality indicators to evaluate the organization of palliative care across Europe: a pilot study in 25 countries.
abstract: BACKGROUND
  A well-organized palliative care service is a prerequisite for offering good palliative care. Reliable and feasible quality indicators are needed to monitor the quality of their organization.
  
  
  OBJECTIVE
  To test feasibility and reliability of a previously developed set of quality indicators in settings and services that provide palliative care across Europe.
  
  
  METHODS
  A total of 38 quality indicators, applicable in all types of settings, rated in a RAND Delphi process, and operationalized into 38 yes/no questions, were used. Descriptives statistics, factor and reliability analyses, analysis of variance, and chi-square analyses were used.
  
  
  METHODS
  Cross-sectional online survey.
  
  
  METHODS
  Questionnaires were sent to representatives of 217 palliative care settings in 25 countries. Included settings were hospices, inpatient dedicated palliative care beds, palliative care outpatient clinics, palliative care units, day care centers for palliative care, palliative care home support teams, inpatient palliative care support teams, care homes, and nursing homes.
  
  
  RESULTS
  All invited 25 European Association of Palliative Care countries took part. In total, 107 out of 217 participants responded (57%). The quality indicators were reduced to four coherent sub-scales, being "equipment and continuity of care," "structured documentation of essential palliative care elements in the medical record," "training and appraisal of personnel," and "availability of controlled drugs." No significant differences in quality criteria between the different types of settings and services were identified.
  
  
  CONCLUSIONS
  The set of quality indicators appeared to measure four reliable domains that assess the organization of different palliative care settings. It can be used as a starting point for quality improvement activities.
authors: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands Yvonne.Engels@radboudumc.nl.
authors: Kathrin
authors: K
authors: Woitha
authors: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Jeroen
authors: J
authors: Hasselaar
authors: Department of Radiotherapy-Oncology and Palliative Medicine, University Hospital Leuven, Leuven, Belgium.
authors: Karen
authors: K
authors: van Beek
authors: Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK.
authors: Nisar
authors: N
authors: Ahmed
authors: Palliative Care Centre, Department of Palliative Medicine, Malteser Hospital Bonn/Rhein-Sieg, University of Bonn, Bonn, Germany Department of Palliative Medicine, Georg-August-University of Göttingen, Göttingen, Germany.
authors: Birgit
authors: B
authors: Jaspers
authors: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Jan C M
authors: JC
authors: Hendriks
authors: Palliative Care Centre, Department of Palliative Medicine, Malteser Hospital Bonn/Rhein-Sieg, University of Bonn, Bonn, Germany.
authors: Lukas
authors: L
authors: Radbruch
authors: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Kris
authors: K
authors: Vissers
authors: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Yvonne
authors: Y
authors: Engels
mesh_terms: D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D003697:Delphi Technique; D004502:Education, Medical, Continuing; D005060:Europe / Q000453:epidemiology; D005240:Feasibility Studies; D006801:Humans; D008499:Medical Records / Q000592:standards; D010166:Palliative Care / Q000458:organization & administration* / Q000592:standards*; D004364:Pharmaceutical Preparations / Q000600:supply & distribution; D010865:Pilot Projects; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards; D015203:Reproducibility of Results
chemical_list: D004364:Pharmaceutical Preparations
keywords: Europall; Quality indicators; applicability; organization; pilot; settings