title: Hospitalizations of cancer patients in the last month of life: quality indicator scores reveal large variation between four European countries in a mortality follow-back study.
abstract: BACKGROUND
  Repeated and long hospitalizations of cancer patients at the end of life have been suggested as indicators of low quality of palliative care. Comparing the care delivered between different countries with the help of these quality indicators may identify opportunities to improve practice. Our objective is twofold: firstly, to describe the scores for the existing quality indicators "the percentage of time spent in hospital" and "the proportion of adult patients with more than one hospitalization in the last 30 days of life" in populations of cancer patients in four European countries and to see whether these countries met previously defined performance standards; secondly, to assess whether these scores are related to receiving palliative care from their GP.
  
  
  METHODS
  A mortality follow-back study was conducted, based on data recorded by representative GP networks for samples of cancer patients living at home who died non-suddenly in Belgium (n = 500), the Netherlands (n = 310), Italy (n = 764), and Spain (n = 224).
  
  
  RESULTS
  The quality indicator score for "the percentage of time spent in hospital" in the last month of life was 14.1% in the Netherlands, 17.7% in Spain, 22.2% in Italy, and 24.6% in Belgium, which means that none of the countries met the performance standard of <10%. For the "proportion of patients with more than one hospitalization in the last 30 days of life", two countries met the performance standard of <4%: the Netherlands (0.6%) and Italy (3.1%). Spain had a score of 4.0% and Belgium scored 5.4%. When patients received palliative care from their GP, significantly less time was spent in hospital in the last month and fewer hospitalizations took place.
  
  
  CONCLUSIONS
  European countries differ regarding the frequency and duration of hospitalizations of cancer patients in the last month of life. This reflects country-specific differences in the organization of palliative care and highlights the important role of the GP in palliative care provision.
authors: Department of Public and Occupational Health, Expertise Center of Palliative Care, VU University Medical Center, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
authors: Maaike L
authors: ML
authors: De Roo
authors: Department of Public and Occupational Health, Expertise Center of Palliative Care, VU University Medical Center, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands ; NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands.
authors: Anneke L
authors: AL
authors: Francke
authors: Vrije Universiteit Brussel (VUB), End-of-life Care Research Group Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium.
authors: Lieve
authors: L
authors: Van den Block
authors: NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands.
authors: Gé A
authors: GA
authors: Donker
authors: Public Health Directorate General, Regional Ministry of Health, Government of Castilla y León, Paseo de Zorrilla 1, 47071 Valladolid, Spain.
authors: Jose E Lozano
authors: JE
authors: Alonso
authors: Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute, ISPO, via Oblate 2, Pal 28/A, 50141 Florence, Italy.
authors: Guido
authors: G
authors: Miccinesi
authors: Scientific Institute of Public Health, Public Health and Surveillance, Health Services Research, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
authors: Sarah
authors: S
authors: Moreels
authors: Department of Public and Occupational Health, Expertise Center of Palliative Care, VU University Medical Center, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
authors: Bregje D
authors: BD
authors: Onwuteaka-Philipsen
authors: Italian Society of General Practioners (SIMG), Via del Pignoncino 9-11, 50142 Florence, Italy.
authors: Andrea
authors: A
authors: Salvetti
authors: Department of Public and Occupational Health, Expertise Center of Palliative Care, VU University Medical Center, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands ; Vrije Universiteit Brussel (VUB), End-of-life Care Research Group Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium.
authors: Luc
authors: L
authors: Deliens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001530:Belgium / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D058006:General Practice; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D009426:Netherlands / Q000453:epidemiology; D010166:Palliative Care / Q000592:standards / Q000706:statistics & numerical data*; D011159:Population Surveillance; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D013030:Spain / Q000453:epidemiology
keywords: Hospitalizations; Palliative care; Quality indicators