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  • Measure Summary
  • NQMC:004978
  • Feb 2009

End-of-life care: percentage of healthcare professionals who affirm that in their unit or area enquiries are always made about terminal patients' preferences regarding life-support procedures and treatment.

Ministry of Health. Safe practices indicators project: background, summary of methods and measurement strategies. Madrid: Ministry of Health; 2009 Feb 20. 97 p.

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in February 2017.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to determine the percentage of healthcare professionals who affirm that in their unit or area enquiries are always made about terminal patients' preferences regarding life-support procedures and treatment.

The following survey item may be added to the "Safety Culture" survey instrument:

  • "In the case of probably terminal patients, enquiries are made in advance about their preferences regarding life-support procedures and treatment. (Respond only if you provide care to probably terminal patients in your area)."

Possible answer: never / almost never / sometimes / almost always / always

Rationale

The provision of unwanted end-of-life care is an adverse event that can be avoided by the implementation of effective patient communication. Written documentation about patient preferences indicates that the patient and his or her family have given thought to this important issue and have stated preferences in the form of a written advance directive.

Main aim of indicator: to improve healthcare quality by always enquiring about terminal patients' preferences. The rate should increase over time.

Evidence for Rationale

Ministry of Health. Safe practices indicators project: background, summary of methods and measurement strategies. Madrid: Ministry of Health; 2009 Feb 20. 97 p.

Primary Health Components

Terminal patients; life-support procedures and treatment; patient preferences

Denominator Description

Total number of healthcare professionals responding to the following item in the "Safety Culture" survey:

  • "In the case of probably terminal patients, enquiries are made in advance about their preferences regarding life-support procedures and treatment. (Respond only if you provide care to probably terminal patients in your area)."

Possible answer: never / almost never / sometimes / almost always / always

Numerator Description

Respondents indicating "always" x 100

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • A systematic review of the clinical research literature (e.g., Cochrane Review)
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

12.4% + 1.6 (95% CI) of heathcare professionals affirm that in their unit or area enquiries are always made about terminal patients' preferences regarding life-support procedures and treatments.

Evidence for Additional Information Supporting Need for the Measure

Ministerio de Sanidad y Consumo. Indicadores de buenas practicas sobre seguridad del paciente. Resultados de su medicion en una muestra de hospitales del sistema nacional de salud Español. Madrid: Ministerio de Sanidad y Consumo; 2008. 95 p.

Extent of Measure Testing

After pilot testing, the set of indicators has been measured in a random sample of 25 Spanish hospitals, stratified by hospital size. The main objective has been to field test the feasibility of measurement in the various settings representing real life situations in the context of the Spanish Health Care System.

Both the whole indicators validation report and the results of the baseline measurement in a sample of the Spanish National Health Service (NHS) hospitals may be accessed and downloaded from the Spanish Ministry of Health web page (in Spanish):

Evidence for Extent of Measure Testing

Ministerio de Sanidad y Consumo. Construccion y validacion de indicadores de buenas practicas sobre seguridad del paciente. Madrid: Ministerio de Sanidad y Consumo; 2008. 178 p.

Ministerio de Sanidad y Consumo. Indicadores de buenas practicas sobre seguridad del paciente. Resultados de su medicion en una muestra de hospitales del sistema nacional de salud Español. Madrid: Ministerio de Sanidad y Consumo; 2008. 95 p.

Ministry of Health. Safe practices indicators project: background, summary of methods and measurement strategies. Madrid: Ministry of Health; 2009 Feb 20. 97 p.

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Hospital Inpatient

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Unspecified

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Person- and Family-centered Care

IOM Care Need

End of Life Care

IOM Domain

Patient-centeredness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Institutionalization

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Total number of healthcare professionals responding to the following item in the "Safety Culture" survey:

  • "In the case of probably terminal patients, enquiries are made in advance about their preferences regarding life-support procedures and treatment. (Respond only if you provide care to probably terminal patients in your area)."

Possible answer: never / almost never / sometimes / almost always / always

Exclusions
None

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Respondents indicating "always" x 100

Exclusions
None

Numerator Search Strategy

Fixed time period or point in time

Data Source

Health professional survey

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

"Safety Culture" survey instrument

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Percentage of healthcare professionals who affirm that in their unit or area enquiries are always made about terminal patients' preferences regarding life-support procedures and treatment.

Measure Collection Name

Safe Practices Indicators Project

Measure Set Name

Facilitating Information Transfer and Clear Communication

Measure Subset Name

End-of-life Care

Submitter

Spanish Agency for Healthcare Quality of the Spanish Ministry of Health - National Government Agency [Non-U.S.]

Developer

Grupo de Investigación sobre Gestión de la Calidad en Servicios de Salud, University of Murcia, under contract to the Spanish Ministry of Health - National Government Agency [Non-U.S.]

Funding Source(s)

Agency for Quality, Spanish Ministry of Health

Composition of the Group that Developed the Measure

Saturno, Pedro J., MD, DrPH; Group Director and Project PI

Castillo, Carmen; López, M. José; Ramón, Teresa; Nurses

Carrillo, Andrés, MD; Intensive Care Specialist

Iranzo, M. Dolores; Hospital pharmacist

Soria, Victor, MD; Surgeon

Parra, Pedro, MD; Gomis, Rafael, MD; Gascón, Juan J., MD; Quality Management Specialists

Financial Disclosures/Other Potential Conflicts of Interest

Project entirely financed by the Spanish Ministry of Health.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2009 Feb

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in February 2017.

Source(s)

Ministry of Health. Safe practices indicators project: background, summary of methods and measurement strategies. Madrid: Ministry of Health; 2009 Feb 20. 97 p.

Measure Availability

Source not available electronically.

For more information, contact:

  • Ministry of Health and Social Policy, at Paseo del Prado, 18-20, planta baja, esquina con Lope de Vega. 28014 Madrid; Phone: +34 901 400 100; Fax: +34 915 96 44 80; Web site: www.msc.es/en/home.htm External Web Site Policy.

    OR

  • Pedro J. Saturno, Facultad de Medicina, at Universidad de Murcia, 30100 Espinardo-Murcia (Spain); Phone: 868 883 948; Fax: +34 868 883947; E-mail: psaturno@um.es.

Companion Documents

The following are available:

  • Ministerio de Sanidad y Consumo. Construccion y validacion de indicadores de buenas practicas sobre seguridad del paciente. Madrid: Ministerio de Sanidad y Consumo; 2008. 178 p. This document is available in Portable Document Format (PDF) from the Ministry of Health and Social Policy Web site External Web Site Policy (in Spanish).
  • Ministerio de Sanidad y Consumo. Indicadores de buenas practicas sobre seguridad del paciente. Resultados de su medicion en una muestra de hospitales del sistema nacional de salud Español. Madrid: Ministerio de Sanidad y Consumo; 2008. 95 p. This document is available in PDF from the Ministry of Health and Social Policy Web site External Web Site Policy (in Spanish).

NQMC Status

This NQMC summary was completed by ECRI Institute on August 21, 2009. The information was verified by the measure developer on October 16, 2009.

This NQMC summary was retrofitted into the new template on July 26, 2011.

The information was reaffirmed by the measure developer on February 20, 2017.

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