Variations in Clinical Practice: Assessing Clinical Care Processes According to Clinical Guidelines in a National Cohort of Hospice Patients
de Graaf, Everlien; Grant, Matthew; van de Baan, Frederieke; Ausems, Marijke; Verboeket-Crul, Cathelijne; Leget, Carlo; Teunissen, Saskia
(2023) The American journal of hospice & palliative care, volume 40, issue 1, pp. 87 - 95
(Article)
Abstract
Background: National clinical guidelines have been developed internationally to reduce variations in clinical practices and promote the quality of palliative care. In The Netherlands, there is considerable variability in the organisation and care processes of inpatient palliative care, with three types of hospices - Volunteer-Driven Hospices (VDH), Stand-Alone Hospices (SAH),
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and nursing home Hospice Units (HU). Aim: This study aims to examine clinical practices in palliative care through different hospice types and identify variations in care. Methods: Retrospective cohort study utilising clinical documentation review, including patients who received inpatient palliative care at 51 different hospices and died in 2017 or 2018. Care provision for each patient for the management of pain, delirium and palliative sedation were analysed according to the Dutch national guidelines. Results: 412 patients were included: 112 patients who received treatment for pain, 53 for delirium, and 116 patients underwent palliative sedation therapy. Care was provided in accordance with guidelines for pain in 32%, 61% and 47% (P = .047), delirium in 29%, 78% and 79% (P = .0016), and palliative sedation in 35%, 63% and 42% (P = .067) of patients who received care in VDHs, SAHs and HUs respectively. When all clinical practices were considered, patient care was conducted according to the guidelines for 33% of patients in VDHs, 65% in SAHs, and 50% in HUs (P < .001). Conclusions: The data demonstrate that care practices are not standardised throughout Dutch hospices and exhibit significant variations between type of hospice.
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Keywords: delirium, guidelines, hospice, pain, palliative care, palliative sedation, quality care, General Medicine, Journal Article
ISSN: 1049-9091
Publisher: SAGE Publications Inc.
Note: Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was funded through The Netherlands Organisation for Health Research and Development (ZonMW) - project number 844001406. Funding Information: We wish to thank all the patients, hospices and staff members (volunteers and professionals) across The Netherlands who participated in this research. Additionally, the members of the guide panels, project group, Septet, Actiz, AHzN, VPTZ, IKNL, Fibula, PalHag, Zorgbelang and Raedelijn, who all contributed significantly to shaping this work. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was funded through The Netherlands Organisation for Health Research and Development (ZonMW) - project number 844001406. Publisher Copyright: © The Author(s) 2022.
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