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Comparison of prospective and retrospective indicators of the quality of end-of-life cancer care.
Setoguchi, Soko; Earle, Craig C; Glynn, Robert; Stedman, Margaret; Polinski, Jennifer M; Corcoran, Colleen P; Haas, Jennifer S.
Afiliação
  • Setoguchi S; Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120-1613, USA.
J Clin Oncol ; 26(35): 5671-8, 2008 Dec 10.
Article em En | MEDLINE | ID: mdl-19001333
ABSTRACT

PURPOSE:

To compare prospectively and retrospectively defined benchmarks for the quality of end-of-life care, including a novel indicator for the use of opiate analgesia.

METHODS:

Linked claims and cancer registry data from 1994 to 2003 for New Jersey and Pennsylvania were used to examine prospective and retrospective benchmarks for seniors with breast, colorectal, lung, or prostate cancer who participated in state pharmaceutical benefit programs.

RESULTS:

Use of opiates, particularly long-acting opiates, was low in both the prospective and retrospective cohorts (9.1% and 10.1%, respectively), which supported the underuse of palliative care at the end-of-life. Although hospice was used more commonly in the retrospective versus prospective cohort, admission to hospice within 3 days of death was similar in both cohorts (28.8% v 26.4%), as was the rate of death in an acute care hospital. Retrospective and prospective measures identified similar physician and hospital patterns of end-of-life care. In multivariate models, a visit with an oncologist was positively associated with the use of chemotherapy, opiates, and hospice. Patients who were cared for by oncologists in small group practices were more likely to receive chemotherapy (retrospective only) and less likely to receive hospice (both) than those in large groups. Compared with patients who were cared for in teaching hospitals, those in other hospitals were more likely to receive chemotherapy (both) and to have toxicity (prospective) but were less likely to receive opiates (both) and hospice (retrospective).

CONCLUSION:

Retrospective and prospective measures, including a new measure of the use of opiate analgesia, identify some similar physician and hospital patterns of end-of-life care.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cuidados Paliativos / Qualidade de Vida / Padrões de Prática Médica / Indicadores de Qualidade em Assistência à Saúde / Pesquisa sobre Serviços de Saúde / Analgésicos Opioides / Neoplasias Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male País como assunto: America do norte Idioma: En Ano de publicação: 2008 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cuidados Paliativos / Qualidade de Vida / Padrões de Prática Médica / Indicadores de Qualidade em Assistência à Saúde / Pesquisa sobre Serviços de Saúde / Analgésicos Opioides / Neoplasias Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male País como assunto: America do norte Idioma: En Ano de publicação: 2008 Tipo de documento: Article