Comparing quality indicator rates for home care clients receiving palliative and end-of-life care before and during the Covid-19 pandemic
Abstract Background The consensus among Canadians with regards to end-of-life preferences is that with adequate support the majority prefer to live and die at home. Purpose To compare quality indicator (QI) rates for home care clients receiving palliative and end-of-life care prior to and after the...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-01-01
|
| Series: | BMC Palliative Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12904-023-01336-9 |
| _version_ | 1797362768597221376 |
|---|---|
| author | Julia Kruizinga Kathryn Fisher Dawn Guthrie Melissa Northwood Sharon Kaasalainen |
| author_facet | Julia Kruizinga Kathryn Fisher Dawn Guthrie Melissa Northwood Sharon Kaasalainen |
| author_sort | Julia Kruizinga |
| collection | DOAJ |
| description | Abstract Background The consensus among Canadians with regards to end-of-life preferences is that with adequate support the majority prefer to live and die at home. Purpose To compare quality indicator (QI) rates for home care clients receiving palliative and end-of-life care prior to and after the onset of the COVID-19 pandemic. Methods A retrospective population-based cohort design was used. Sixteen QIs informed by existing literature and a preliminary set of QIs recently evaluated by a modified Delphi panel were compared. Data were obtained from the interRAI Palliative Care instrument for Ontario home care clients for two separate cohorts: the pre-COVID (January 14, 2019 to March 16, 2020) and COVID cohort (March 17, 2020 to May 18, 2021). A propensity score analysis was used to match (using nearest neighbour matching) on 21 covariates, resulting in a sample size of 2479 unique interRAI Palliative Care assessments in each cohort. Alternative propensity score methods were explored as part of a sensitivity analysis. Results After matching the pre-COVID and COVID cohorts, five of the 16 QIs had statistically significant differences in the QI rates (change from pre-COVID to COVID): decrease in prevalence of severe or excruciating daily pain (p = 0.03, effect size=-0.08), decrease in prevalence of caregiver distress (p = 0.02, effect size=-0.06), decrease in prevalence of negative mood (p = 0.003, effect size=- 0.17), decrease in prevalence of a delirium-like syndrome (p = 0.001, effect size=-0.25) and decrease in prevalence of nausea or vomiting (p = 0.04, effect size=-0.06). While the alternative propensity score methods produced slightly different results, no clinically meaningful differences were seen between the cohorts when effect sizes were examined. All methods were in agreement regarding the highest QI rates, which included the prevalence of shortness of breath with activity, no advance directives, and fatigue. Conclusion This study is the first to examine differences in QI rates for home care clients receiving palliative and end-of-life care before and during COVID in Ontario. It appears that QI rates did not change over the course of the pandemic in this population. Future work should be directed to understanding the temporal variation in these QI rates, risk-adjusting the QI rates for further comparison among jurisdictions, provinces, and countries, and in creating benchmarks for determining acceptable rates of different QIs. |
| first_indexed | 2024-03-08T16:11:15Z |
| format | Article |
| id | doaj.art-45dae0df65f74a10bb39841de8645c3b |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-03-08T16:11:15Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-45dae0df65f74a10bb39841de8645c3b2024-01-07T12:54:00ZengBMCBMC Palliative Care1472-684X2024-01-012311910.1186/s12904-023-01336-9Comparing quality indicator rates for home care clients receiving palliative and end-of-life care before and during the Covid-19 pandemicJulia Kruizinga0Kathryn Fisher1Dawn Guthrie2Melissa Northwood3Sharon Kaasalainen4McMaster UniversitySchool of Nursing, McMaster UniversityDepartment of Kinesiology and Physical Education, Wilfrid Laurier UniversitySchool of Nursing, McMaster UniversitySchool of Nursing, McMaster UniversityAbstract Background The consensus among Canadians with regards to end-of-life preferences is that with adequate support the majority prefer to live and die at home. Purpose To compare quality indicator (QI) rates for home care clients receiving palliative and end-of-life care prior to and after the onset of the COVID-19 pandemic. Methods A retrospective population-based cohort design was used. Sixteen QIs informed by existing literature and a preliminary set of QIs recently evaluated by a modified Delphi panel were compared. Data were obtained from the interRAI Palliative Care instrument for Ontario home care clients for two separate cohorts: the pre-COVID (January 14, 2019 to March 16, 2020) and COVID cohort (March 17, 2020 to May 18, 2021). A propensity score analysis was used to match (using nearest neighbour matching) on 21 covariates, resulting in a sample size of 2479 unique interRAI Palliative Care assessments in each cohort. Alternative propensity score methods were explored as part of a sensitivity analysis. Results After matching the pre-COVID and COVID cohorts, five of the 16 QIs had statistically significant differences in the QI rates (change from pre-COVID to COVID): decrease in prevalence of severe or excruciating daily pain (p = 0.03, effect size=-0.08), decrease in prevalence of caregiver distress (p = 0.02, effect size=-0.06), decrease in prevalence of negative mood (p = 0.003, effect size=- 0.17), decrease in prevalence of a delirium-like syndrome (p = 0.001, effect size=-0.25) and decrease in prevalence of nausea or vomiting (p = 0.04, effect size=-0.06). While the alternative propensity score methods produced slightly different results, no clinically meaningful differences were seen between the cohorts when effect sizes were examined. All methods were in agreement regarding the highest QI rates, which included the prevalence of shortness of breath with activity, no advance directives, and fatigue. Conclusion This study is the first to examine differences in QI rates for home care clients receiving palliative and end-of-life care before and during COVID in Ontario. It appears that QI rates did not change over the course of the pandemic in this population. Future work should be directed to understanding the temporal variation in these QI rates, risk-adjusting the QI rates for further comparison among jurisdictions, provinces, and countries, and in creating benchmarks for determining acceptable rates of different QIs.https://doi.org/10.1186/s12904-023-01336-9Palliative and end-of-life careHome careQuality indicators |
| spellingShingle | Julia Kruizinga Kathryn Fisher Dawn Guthrie Melissa Northwood Sharon Kaasalainen Comparing quality indicator rates for home care clients receiving palliative and end-of-life care before and during the Covid-19 pandemic BMC Palliative Care Palliative and end-of-life care Home care Quality indicators |
| title | Comparing quality indicator rates for home care clients receiving palliative and end-of-life care before and during the Covid-19 pandemic |
| title_full | Comparing quality indicator rates for home care clients receiving palliative and end-of-life care before and during the Covid-19 pandemic |
| title_fullStr | Comparing quality indicator rates for home care clients receiving palliative and end-of-life care before and during the Covid-19 pandemic |
| title_full_unstemmed | Comparing quality indicator rates for home care clients receiving palliative and end-of-life care before and during the Covid-19 pandemic |
| title_short | Comparing quality indicator rates for home care clients receiving palliative and end-of-life care before and during the Covid-19 pandemic |
| title_sort | comparing quality indicator rates for home care clients receiving palliative and end of life care before and during the covid 19 pandemic |
| topic | Palliative and end-of-life care Home care Quality indicators |
| url | https://doi.org/10.1186/s12904-023-01336-9 |
| work_keys_str_mv | AT juliakruizinga comparingqualityindicatorratesforhomecareclientsreceivingpalliativeandendoflifecarebeforeandduringthecovid19pandemic AT kathrynfisher comparingqualityindicatorratesforhomecareclientsreceivingpalliativeandendoflifecarebeforeandduringthecovid19pandemic AT dawnguthrie comparingqualityindicatorratesforhomecareclientsreceivingpalliativeandendoflifecarebeforeandduringthecovid19pandemic AT melissanorthwood comparingqualityindicatorratesforhomecareclientsreceivingpalliativeandendoflifecarebeforeandduringthecovid19pandemic AT sharonkaasalainen comparingqualityindicatorratesforhomecareclientsreceivingpalliativeandendoflifecarebeforeandduringthecovid19pandemic |