Palliative care quality indicators in Italy. What do we evaluate?

Purpose In recent years, the number of palliative serviceproviders has increased significantly. This expansion necessitatesan evaluation in order to provide the basis for qualityimprovement of the care. Policymakers, managers of palliativecare programs, and others committed to the improvementof end-of-life care need methods and criteria to measure andevaluate the care delivered. As quality measurement isexpensive and difficult to undertake, it is fundamental thatquality measures evaluate the right things. Quality evaluationin Italy is supported by health authorities who have developedsome indicators of palliative care. The aims of this study wereto give an overview of these indicators.Methods We analyzed all palliative care indicators developedby Italian national authorities from 2000 to the present. Theseindicators have been divided into three different levels ofanalysis (structure, process, and outcome). Subsequently, tworeviewers have independently compared their degree ofconcordance with domains, and guidelines developed by theNCP for palliative care and after careful discussion an expertpanel has elaborated a final consensus document.Results Most of the quality indicators analyzed deal withthe structure and process of palliative care, however theymiss outcomes and do not cover domains mainly concernedwith spiritual, ethical, cultural, or existential aspects of care.Conclusions More attention should be paid to the developmentof outcome indicators of palliative care. The attemptto identify a group of indicators which cover every domainof palliative care represents a challenge for the future interms of finding new cognitive models more orientedtoward subjectivity.