Charlebois Janie, Cyr Claude
Département de pédiatrie, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Quebec.
Paediatr Child Health. 2015 Apr;20(3):145-7. doi: 10.1093/pch/20.3.145.
To apply quality indicators for paediatric palliative care and evaluate performance in one service provision area.
After institutional review board approval, medical records were abstracted for well-defined and measurable quality indicators for children with chronic complex conditions (CCCs) between January 2006 and December 2011 (n=50) at a university medical centre.
Of the 50 children with a CCC (mean age 64 months, 48% female), 39 (78%) died in hospital, 11 (22%) died at home and 13 (26%) were <1 month of age. In the final month of their life, 10 patients (20%) required an unplanned visit to the emergency department and seven (14%) were admitted. Only four patients (8%) were admitted for >14 days in their final month of life. Goals of care were addressed in a timely manner 60% of the time. An invasive procedure was performed in the final month of life in 27 (44%) patients. Bereavement follow-up was offered to 25 (50%) families. A palliative care consultant was involved with 17 (34%) patients. Palliative care was associated with less frequent invasive procedures in the final month of life and more frequent documentation of the preferred place of death.
Performance on these particular quality indicators was unsatisfactory across a diverse group of children with CCCs, indicating important opportunities for improvement. Methods used to improve the quality of other aspects of paediatric care, including emphasis on efficient work systems, practical tools and interdisciplinary teamwork, should be used for ensuring delivery of high-quality palliative care.
应用儿科姑息治疗质量指标，评估某一服务提供领域的绩效。
经机构审查委员会批准，提取了2006年1月至2011年12月期间（n = 50）在一所大学医学中心患有慢性复杂疾病（CCC）儿童的病历，以获取明确且可衡量的质量指标。
50例患有CCC的儿童（平均年龄64个月，48%为女性）中，39例（78%）在医院死亡，11例（22%）在家中死亡，13例（26%）年龄小于1个月。在生命的最后一个月，10例患者（20%）需要非计划地前往急诊科就诊，7例（14%）入院治疗。仅4例患者（8%）在生命的最后一个月住院时间超过14天。60%的时间里能及时确定护理目标。27例（44%）患者在生命的最后一个月接受了侵入性操作。25个（50%）家庭接受了丧亲后随访。17例（34%）患者有姑息治疗顾问参与。姑息治疗与生命最后一个月侵入性操作频率降低以及更频繁记录首选死亡地点相关。
在患有CCC的不同儿童群体中，这些特定质量指标的表现不尽人意，表明有重要的改进机会。应采用用于提高儿科护理其他方面质量的方法，包括强调高效的工作系统、实用工具和跨学科团队合作，以确保提供高质量的姑息治疗。
