Quality assessment of palliative home care in Italy.
BACKGROUND
The complexity of end-of-life care, represented by a large number of units caring for dying patients, of different types of organizations motivates the importance of measure the quality of provided care. Despite the law 38/2010 promulgated to remove the barriers and provide affordable access to palliative care, measurement, and monitoring of processes of home care providers in Italy has not been attempted.


OBJECTIVE
Using data drawn by an institutional voluntary observatory established in Italy in 2013, collecting home palliative care units caring for people between January and December 2013, we assess the degree to which Italian home palliative care teams endorse a set of standards required by the 38/2010 law and best practices as emerged from the literature.


METHODS
The evaluation strategy is based on Rasch analysis, allowing to objectively measuring both performances of facilities and quality indicators' difficulty on the same metric, using 14 quality indicators identified by the observatory's steering committee.


RESULTS
Globally, 195 home care teams were registered in the observatory reporting globally 40 955 cured patients in 2013 representing 66% of the population of home palliative care units active in Italy in 2013. Rasch analysis identifies 5 indicators ("interview" with caregivers, continuous training provided to medical and nursing staff, provision of specialized multidisciplinary interventions, psychological support to the patient and family, and drug supply at home) easy to endorse by health care providers and 3 problematic indicators (presence of a formally established Local Network of Palliative care in the area of reference, provision of the care for most problematic patient requiring high intensity of the care, and the percentage of cancer patient dying at Home).


CONCLUSIONS
The lack of Local Network of Palliative care, required by law 38/2010, is, at the present, the main barrier to its application. However, the adopted methodology suggests that a clear roadmap for health facilities to afford future quality and normative challenges.
Department of Frailty, Local social health authority (ASST) Lecco, Local Network of Palliative care, Merate, Italy.
Gianlorenzo
G
Scaccabarozzi
Department of Statistics and Quantitative Methods, and CRISP, University of Milano-Bicocca, Milan, Italy.
Pietro Giorgio
http://orcid.org/0000-0002-2340-0547
PG
Lovaglio
Health Protection Agency (ATS) Montagna, Sondrio, Italy.
Fabrizio
F
Limonta
Floriani Foundation, Milan, Italy.
Maddalena
M
Floriani
Floriani Foundation, Milan, Italy.
Giacomo
G
Pellegrini
D019985:Benchmarking; D017028:Caregivers; D006699:Home Care Services / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D007558:Italy; D010166:Palliative Care / Q000458:organization & administration* / Q000592:standards; D010348:Patient Care Team; D036301:Qualitative Research; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D013727:Terminal Care / Q000458:organization & administration* / Q000592:standards
Italian National Law 38/2010; Rasch analysis; evaluation; home palliative care; quality challenges; quality standards