Back to Search
Start Over
Quality indicators for the evaluation of end-of-life care in Germany - a retrospective cross-sectional analysis of statutory health insurance data.
- Source :
-
BMC palliative care [BMC Palliat Care] 2020 Dec 08; Vol. 19 (1), pp. 187. Date of Electronic Publication: 2020 Dec 08. - Publication Year :
- 2020
-
Abstract
- Background: The provision and quality of end-of-life care (EoLC) in Germany is inconsistent. Therefore, an evaluation of current EoLC based on quality indicators is needed. This study aims to evaluate EoLC in Germany on the basis of quality indicators pertaining to curative overtreatment, palliative undertreatment and delayed palliative care (PC). Results were compared with previous findings.<br />Methods: Data from a statutory health insurance provider (AOK Lower Saxony) pertaining to deceased members in the years 2016 and 2017 were used to evaluate EoLC. The main indicators were: chemotherapy for cancer patients in the last month of life, first-time percutaneous endoscopic gastrostomy (PEG) for patients with dementia in the last 3 months of life, number of hospitalisations and days spent in inpatient treatment in the last 6 months of life, and provision of generalist and specialist outpatient PC in the last year of life. Data were analysed descriptively.<br />Results: Data for 64,275 deceased members (54.3% female; 35.1% cancer patients) were analysed. With respect to curative overtreatment, 10.4% of the deceased with cancer underwent chemotherapy in the last month and 0.9% with dementia had a new PEG insertion in the last 3 months of life. The mean number of hospitalisations and inpatient treatment days per deceased member was 1.6 and 16.5, respectively, in the last 6 months of life. Concerning palliative undertreatment, generalist outpatient PC was provided for 28.0% and specialist outpatient PC was provided for 9.0% of the deceased. Regarding indicators for delayed PC, the median onset of generalist and specialist outpatient PC was 47.0 and 24.0 days before death, respectively.<br />Conclusion: Compared to data from 2010 to 2014, the data analysed in the present study suggest an ongoing curative overtreatment in terms of chemotherapy and hospitalisation, a reduction in new PEG insertions and an increase in specialist PC. The number of patients receiving generalist PC remained low, with delayed onset. Greater awareness of generalist PC and the early integration of PC are recommended.<br />Trial Registration: The study was registered in the German Clinical Trials Register ( DRKS00015108 ; 22 January 2019).
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Cross-Sectional Studies
Data Analysis
Female
Germany
Humans
Male
Middle Aged
Retrospective Studies
Terminal Care methods
Terminal Care statistics & numerical data
Insurance, Health statistics & numerical data
Quality Indicators, Health Care statistics & numerical data
Terminal Care standards
Subjects
Details
- Language :
- English
- ISSN :
- 1472-684X
- Volume :
- 19
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC palliative care
- Publication Type :
- Academic Journal
- Accession number :
- 33292204
- Full Text :
- https://doi.org/10.1186/s12904-020-00679-x