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. 2012 Aug 30;2(4):e001328.
doi: 10.1136/bmjopen-2012-001328. Print 2012.

Registration in a quality register: a method to improve end-of-life care--a cross-sectional study

Lisa Martinsson  1 , Carl Johan Fürst, Staffan Lundström, Lena Nathanaelsson, Bertil Axelsson
Affiliations

Registration in a quality register: a method to improve end-of-life care--a cross-sectional study

Lisa Martinsson et al. BMJ Open. .

Abstract

Objectives: Structured methods to assess and support improvement in the quality of end-of-life care are lacking and need to be developed. This need is particularly high outside the specialised palliative care. This study examines whether participation in a national quality register increased the quality of end-of-life care.

Design: This study is a cross-sectional longitudinal register study.

Setting: The Swedish Register of Palliative Care (SRPC) collects data about end-of-life care for deaths in all types of healthcare units all over Sweden. Data from all 503 healthcare units that had reported patients continuously to the register during a 3-year period were analysed.

Primary and secondary outcome measures: Data on provided care during the last weeks of life were compared year-by-year with logistic regression.

Participants: The study included a total 30 283 patients. The gender distribution was 54% women and 46% men. A total of 60% of patients in the study had a cancer diagnosis.

Results: Provided end-of-life care improved in a number of ways. The prevalence of six examined symptoms decreased. The prescription of 'as needed' medications for pain, nausea, anxiety and death rattle increased. A higher proportion of patients died in their place of preference. The patient's next of kin was more often offered a follow-up appointment after the patient's death. No changes were seen with respect to providing information to the patient or next of kin.

Conclusions: Participation in a national quality register covariates with quality improvements in end-of-life care over time.

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Figures

Figure 1
Figure 1
Question number 17 from the end-of-life questionnaire: Mark the symptom(s) that was/were not fully alleviated during the last week of life. *p<0.05, **p<0.01, ***p<0.001 and n=7584–11 409 per year.
Figure 2
Figure 2
Question number 20 from the end-of-life questionnaire: Was ‘as needed’ medication prescribed in the form of injections at least 1 day before death against pain, anxiety, death rattle and/or nausea? ***p<0.001 and n=7584–11 409 per year.
See this image and copyright information in PMC

References

    1. The Swedish Register of Palliative Care (Annual report from the Swedish Register of Palliative Care fiscal year 2010.) http://www.palliativ.se/html/sve/Arsrapport/Palliativregistret2011.pdf (accessed 1 Jul 2011).
    1. Socialstyrelsen (Causes of death 2008.) Stockholm: Socialstyrelsen, 2010
    1. Rosén M. (Review of national quality registers. Gold mine in care. Proposal for a joint initiative from 2011 to 2015.) http://brs.skl.se/brsbibl/kata_documents/doc39859_1.pdf (accessed 23 Jun 2011).
    1. Lundström S, Axelsson B, Heedman P-A, et al. Developing a national quality register in end-of-life care: the Swedish experience. Palliat Med 2012;26:313–21 - PubMed
    1. Gómez-Batiste X, Caja C, Espinosa J, et al. Quality improvement in palliative care services and networks: preliminary results of a benchmarking process in Catalonia, Spain. J Palliat Med 2010;13:1237–44 - PubMed