Variations in process and outcome in inpatient palliative care services in Korea

• Published in: Supportive care in cancer Vol. 20; no. 3; pp. 539 - 547
• Main Authors: Choi, Jin Young, Shin, Dong Wook, Kang, Jina, Baek, Young Ji, Mo, Ha Na, Nam, Byung-Ho, Seo, Won Seok, Park, Jong Hyock, Kim, Jung Hoe, Jung, Kee Taig
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-03-2012; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Cancer; Cancer patients; Comorbidity; Female; Home Care Services - utilization; Hospices (Terminal care); Hospitalization - statistics & numerical data; Humans; Inpatients - statistics & numerical data; Korea; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasms - classification; Neoplasms - mortality; Neoplasms - therapy; Nursing; Nursing Research; Oncology; Original Article; Outcome and Process Assessment (Health Care) - methods; Pain - epidemiology; Pain Measurement; Pain Medicine; Palliative care; Palliative Care - methods; Palliative Care - standards; Palliative Care - statistics & numerical data; Palliative treatment; Patient Education as Topic; Patient outcomes; Quality Improvement - organization & administration; Quality of care; Rehabilitation Medicine; Republic of Korea; Social service; Survival Rate; Terminal Care - methods; Terminal Care - statistics & numerical data; Volunteerism; Young Adult; Republic of Korea; Korea; South Korea; Korean Terminal Cancer Patient Information System (KTCPIS); Palliative care; Process; Variation; Quality; Outcomes
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-011-1115-y

Purposes
Hospice programs in Korea have been largely based on volunteer activity, religious services, or social services. Recent government policy of designating medically based inpatient palliative care services and per diem payment system made it necessary to monitor the quality of these services. We examined the variation in the process and outcomes of palliative care services, using 2009 data obtained from the Korean Terminal Cancer Patient Information System.
Methods
Data were collected from 3,867 patients with terminal cancer who were registered in 34 inpatient palliative care centers designated by the Ministry of Health and Welfare. We used the mean length of stay and the subsequent place of care as process indicators, and change in average pain score as an outcome indicator. The data were analyzed using descriptive statistics, and analysis of covariance for the case-mix adjustment.
Results
There were considerable variations among services with regards to the mean length of stay (i.e., 10.5 to 32.6 days for each admission) and subsequent place of care (i.e., 39.8% to 92.6% ended in death at the first admission), even after stratification by service level. The mean change in average pain score varied from −1.48 to 2.16, and remained significant after case-mix adjustment.
Conclusion
We found considerable variations among palliative care services with regard to the mean length of stay, subsequent place of care, and change in average pain score. Continued assessment of the variations in process and outcomes will assist in developing the national benchmarking system and the evaluation of the government policy.