title: Organization and evaluation of generalist palliative care in a Danish hospital.
abstract: BACKGROUND
  Hospitals have a responsibility to ensure that palliative care is provided to all patients with life-threatening illnesses. Generalist palliative care should therefore be acknowledged and organized as a part of the clinical tasks. However, little is known about the organization and evaluation of generalist palliative care in hospitals. Therefore the aim of the study was to investigate the organization and evaluation of generalist palliative care in a large regional hospital by comparing results from existing evaluations.
  
  
  METHODS
  Results from three different data sets, all aiming to evaluate generalist palliative care, were compared retrospectively. The data-sets derived from; 1. a national accreditation of the hospital, 2. a national survey and 3. an internal self-evaluation performed in the hospital. The data were triangulated to investigate the organization and evaluation of palliative care in order to identify concordances and/or discrepancies.
  
  
  RESULTS
  The triangulation indicated poor validity of the results from existing methods used to evaluate palliative care in hospitals. When the datasets were compared, several discrepancies occurred with regard to the organization and the performance of generalist palliative care. Five types of discrepancies were found in 35 out of 56 sections in the fulfilment of the national accreditation standard for palliative care. Responses from the hospital management and the department managements indicated that generalist palliative care was organized locally--if at all--within the various departments and with no overall structure or policy.
  
  
  CONCLUSIONS
  This study demonstrates weaknesses in the existing evaluation methods for generalist palliative care and highlights the lack of an overall policy, organization and goals for the provision of palliative care in the hospital. More research is needed to focus on the organization of palliative care and to establish indicators for high quality palliative care provided by the hospital. The lack of valid indicators, both for the hospital's and the departments' provision of palliative care, calls for more qualitative insight in the clinical staff's daily work including their culture and acceptance of the provision of palliative care.
authors.affiliation: The Regional Research Unit, Region Zealand, Denmark. hbz@regionsjaelland.dk.
authors.forename: Heidi
authors.initials: H
authors.lastname: Bergenholtz
authors.affiliation: Roskilde/Køge Hospitals, Region Zealand, Denmark. bibh@regionsjaelland.dk.|The Research Unit for General Practice and Section of General Practice Department of Public Health, University of Copenhagen, Copenhagen, Denmark. bibh@regionsjaelland.dk.
authors.forename: Bibi
authors.initials: B
authors.lastname: Hølge-Hazelton
authors.affiliation: PAVI, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. ljarlbaek@sdu.dk.
authors.forename: Lene
authors.initials: L
authors.lastname: Jarlbaek
mesh_terms: D000068:Accreditation / Q000592:standards; D003625:Data Collection / Q000379:methods; D006302:Health Services Research / Q000458:organization & administration* / Q000592:standards; D006739:Hospital Administration / Q000592:standards*; D006801:Humans; D010166:Palliative Care / Q000458:organization & administration* / Q000592:standards; D015397:Program Evaluation / Q000379:methods* / Q000592:standards*; D011787:Quality of Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies