Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Stockholm, Sweden.
Acta Oncol. 2022 Dec;61(12):1437-1445. doi: 10.1080/0284186X.2022.2153621. Epub 2022 Dec 10.
BACKGROUND: Quality indicators are frequently used to measure the quality of care at the end of life. Whether quality indicators of potential (i.e., when the risks outweigh the benefits) at the end of life can be reliably applied to routinely collected data remains uncertain. This study aimed to identify quality indicators of overtreatment at the end of life in the published literature and to investigate their tentative prevalence among older adults dying with solid cancer. MATERIALS AND METHODS: Retrospective cohort study of decedents including all older adults (≥65 years) who died with solid cancer between 1 January 2013 and 31 December 2015 ( = 54,177) in Sweden. Individual data from the National Cause of Death Register were linked with data from the Total Population Register, the National Patient Register, and the Swedish Prescribed Drug Register. Quality indicators were applied for the last one and three months of life. RESULTS: From a total of 145 quality indicators of overtreatment identified in the literature, 82 (57%) were potentially operationalisable with routine administrative and healthcare data in Sweden. Unidentifiable procedures and hospital drug treatments were the reason for non-operationalisability in 52% of the excluded indicators. Among the 82 operationalisable indicators, 67 measured overlapping concepts. Based on the remaining 15 unique indicators, we tentatively estimated that overall, about one-third of decedents received at least one treatment or procedure indicative of 'potential overtreatment' during their last month of life. CONCLUSION: Almost half of the published overtreatment indicators could not be measured in routine administrative and healthcare data in Sweden due to a lack of means to capture the care procedure. Our tentative estimates suggest that potential overtreatment might affect one-third of cancer decedents near death. However, quality indicators of potential overtreatment for specific use in routinely collected data should be developed and validated.
背景:质量指标常用于衡量生命末期的医疗保健质量。生命末期潜在过度治疗(即风险大于收益时)的质量指标是否可以可靠地应用于常规收集的数据尚不确定。本研究旨在确定生命末期过度治疗的质量指标,并调查其在患有实体瘤的老年死亡患者中的暂定患病率。
材料和方法:回顾性队列研究包括所有在 2013 年 1 月 1 日至 2015 年 12 月 31 日期间死于实体瘤的老年患者(≥65 岁)(n=54177)。来自国家死因登记处的个人数据与总人口登记处、国家患者登记处和瑞典处方药物登记处的数据相关联。质量指标适用于生命的最后一个月和三个月。
结果:在文献中确定的 145 种过度治疗的质量指标中,82 种(57%)在瑞典使用常规行政和医疗保健数据具有潜在可操作性。无法识别的程序和医院药物治疗是 52%被排除指标不可操作性的原因。在 82 个可操作的指标中,有 67 个指标测量的是重叠概念。基于其余 15 个独特指标,我们暂定估计,在生命的最后一个月,大约有三分之一的死者接受了至少一种治疗或程序,表明存在“潜在过度治疗”。
结论:由于缺乏捕捉护理程序的手段,瑞典近一半的已发表过度治疗指标无法在常规行政和医疗保健数据中进行测量。我们的暂定估计表明,潜在的过度治疗可能会影响三分之一的癌症临终患者。然而,应开发和验证针对特定常规收集数据使用的潜在过度治疗质量指标。
Eur J Cardiovasc Nurs. 2012-4-4