Challenges in supporting lay carers of patients at the end of life: results from focus group discussions with primary healthcare providers

Background: Family caregivers (FCGs) of patients at the end of life (EoL) cared for at home receive support from professional and non-professional care providers. Healthcare providers in general practice play an important role as they coordinate care and establish contacts between the parties concerned. To identify potential intervention targets, this study deals with the challenges healthcare providers in general practice face in EoL care situations including patients, caregivers and networks. Methods: Focus group discussions with general practice teams in Germany were conducted to identify barriers to and enablers of an optimal support for family caregivers. Focus group discussions were analysed using content analysis. Results: Nineteen providers from 11 general practices took part in 4 focus group discussions. Participants identified challenges in communication with patients, caregivers and within the professional network. Communication with patients and caregivers focused on non-verbal messages, communicating at an appropriate time and perceiving patient and caregiver as a unit of care. Practice teams perceive themselves as an important part of the healthcare network, but also report difficulties in communication and cooperation with other healthcare providers. Conclusion: Healthcare providers in general practice identified relational challenges in daily primary palliative care with potential implications for EoL care. Communication and collaboration with patients, caregivers and among healthcare providers give opportunities for improving palliative care with a focus on the patient-caregiver dyad. It is insufficient to demand a (professional) support network; existing structures need to be recognized and included into the care

Systematic literature search - Flow chart.

<p>Systematic literature search - Flow chart.</p

Phases and steps in the development and testing of indicators for colorectal cancer care.

<p>Phases and steps in the development and testing of indicators for colorectal cancer care.</p

N^o of quality indicators identified by systematic search (allocated to the OECD quality model dimensions) [<b>24</b>].

<p>N^o of quality indicators identified by systematic search (allocated to the OECD quality model dimensions) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0060947#pone.0060947-AQUAInstitute1" target="_blank">[<b>24</b>]</a>.</p

Evaluating the Quality of Colorectal Cancer Care across the Interface of Healthcare Sectors

Contains fulltext : 118387.pdf (publisher's version ) (Open Access)BACKGROUND: Colorectal cancer (CRC) has a high prevalence in western countries. Diagnosis and treatment of CRC is complex and requires multidisciplinary collaboration across the interface of health care sectors. In Germany, a new nationwide established program aims to provide quality information of healthcare delivery across different sectors. Within this context, this study describes the development of a set of quality indicators charting the whole pathway of CRC-care including data specifications that are necessary to operationalize these indicators before practice testing. METHODS: Indicators were developed following a systematic 10 step modified 'RAND/UCLA Appropriateness Method' which involved a multidisciplinary panel of thirteen participants. For each indicator in the final set, data specifications relating to sources of quality information, data collection procedures, analysis and feedback were described. RESULTS: The final indicator set included 52 indicators covering diagnostic procedures (11 indicators), therapeutic management (28 indicators) and follow-up (6 indicators). In addition, 7 indicators represented patient perspectives. Primary surgical tumor resection and pre-operative radiation (rectum carcinoma only) were perceived as most useful tracer procedures initiating quality data collection. To assess the quality of CRC care across sectors, various data sources were identified: medical records, administrative inpatient and outpatient data, sickness-funds billing code systems and patient survey. CONCLUSION: In Germany, a set of 52 quality indicators, covering necessary aspects across the interfaces and pathways relevant to CRC-care has been developed. Combining different sectors and sources of health care in quality assessment is an innovative and challenging approach but reflects better the reality of the patient pathway and experience of CRC-care

Quality indicators of CRC care included in the final set (for detailed description see Table S1).

*<p>Data sources: 1: Inpatient administrative and/or reimbursement data (OPS-codes), 2: Outpatient administrative and/or reimbursement data (fee schedule items), 3: Prospectively collected clinical data, 4: Retrospectively collected clinical data during tracer procedure, 5: Medical record, 6: Implementation of new procedure codes: OPS-codes (hospital) or fee schedule items (ambulatory sector), 7: Peer review, 8: Patient survey, 9: Administrative data (sickness funds).</p>**<p>Feedback: 10: Healthcare provider level – Benchmarking feedback reports with ‘structured dialogue’ in case of poor results, 11: Area level – multidisciplinary discussion.</p