Development and evaluation of quality indicators of end-of-life care and map healthcare costs in Belgium
Care often tends to focus on cure and life-prolonging treatments until the very last stages of life, even when these are no longer warranted or beneficial. This ‘aggressiveness’ of end-of-life care impacts on the quality and costs in the last phase of life. Until now, no robust population-level evaluation of the quality and costs of end-of-life care exists outside of North America. As collecting population-level data (across settings and types of care) would be an immense and costly effort, the challenge lies in making an efficient use of administratively collected data.
Using high quality full-population health care claims and cancer registry data in Belgium we will address three research aims:
1) to develop a comprehensive and valid set of quality indicators of end-of-life care in cancer, COPD, and dementia and calculate them at a population level
2) to map the direct healthcare costs of end-of-life care at a population level in these illnesses
3) to evaluate the influence of primary care and palliative care services on the quality and costs of end-of-life care
A combination of evidence and stakeholder consensus will be used to develop quality indicators. Administrative full-population healthcare claims and cancer registry data will be used to calculate the quality indicators and the costs. A retrospective cohort design with a propensity score matching method (which is essential in order to compare comparable patients in different settings of the health care system) will be used to evaluate the influence of primary care and palliative care.