gms | German Medical Science

22. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

04.10. - 06.10.2023, Berlin

Development of a data extraction tool for retrospective medical record analysis to evaluate quality of hospital care in the dying phase

Meeting Abstract

  • Sukhvir Kaur - University of Cologne, Faculty of Medicine and University Hospital, Department of Palliative Medicine, Köln
  • Sophie Meesters - University of Cologne, Faculty of Medicine and University Hospital, Department of Palliative Medicine, Köln
  • Annika Dangendorf - University of Cologne, University Hospital Cologne, Department of Nursing, Köln
  • Barbara Strohbücker - University of Cologne, University Hospital Cologne, Department of Nursing, Köln
  • Nikolas Oubaid - Palliative Care Unit, Department of Oncology, Hematology, BMT, University Medical Center Hamburg-Eppendorf, Hamburg
  • Aneta Schieferdecker - Palliative Care Unit, Department of Oncology, Hematology, BMT, University Medical Center Hamburg-Eppendorf, Hamburg
  • Anneke Ullrich - Palliative Care Unit, Department of Oncology, Hematology, BMT, University Medical Center Hamburg-Eppendorf, Hamburg
  • Karin Oechsle - Palliative Care Unit, Department of Oncology, Hematology, BMT, University Medical Center Hamburg-Eppendorf, Hamburg
  • Holger Schulz - Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg
  • Raymond Voltz - University of Cologne, Faculty of Medicine and University Hospital, Department of Palliative Medicine, Köln; University of Cologne, Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Köln; University of Cologne, Faculty of Medicine and University Hospital, Center for Health Services Research, Köln
  • Kerstin Kremeike - University of Cologne, Faculty of Medicine and University Hospital, Department of Palliative Medicine, Köln

22. Deutscher Kongress für Versorgungsforschung (DKVF). Berlin, 04.-06.10.2023. Düsseldorf: German Medical Science GMS Publishing House; 2023. Doc23dkvf466

doi: 10.3205/23dkvf466, urn:nbn:de:0183-23dkvf4665

Published: October 2, 2023

© 2023 Kaur et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background and state of research: In Germany, nearly half of the population dies in hospitals, mostly outside specialised palliative care units. In order to improve the quality of care in the dying phase, national and international guidelines provide quality indicators and outcome variables for optimal care. These can be used for the evaluation of interventions to improve care in the dying phase.

Research question and objectives, hypothesis: The aim was to develop a tool for data extraction from medical records to assess the quality of hospital care in the dying phase.

Method: A data extraction tool was developed by operationalising items based on quality indicators and key recommendations on care in the dying phase from the German national evidenced-based guideline Palliative care for patients with incurable cancer [1]. The tool was then applied to extract data from n=400 medical records of deceased patients of ten general wards and intensive care units of two university hospitals.

Results: The final tool consisted of 59 items related to eight domains:

1.
(Withdrawal of) medications and measures in the dying phase;
2.
Involvement of specialist palliative care teams;
3.
Progress documentation;
4.
Continuity of care;
5.
Symptom assessment;
6.
Principles and practical issues of care in the dying phase;
7.
Artificial nutrition and hydration,
8.
Dialysis, ventilation, tumour-specific therapy.

The created items proved to be applicable for all domains on medical records of deceased patients. Information density on the different domains varied considerably within medical records. On average, most documented information could be found on the domain (withdrawal of) medication and measures (94, 1% of records) followed by the domain artificial nutrition and hydration (69, 9% of records). Fewest indications could be found in the area of principles and practical issues, e.g. shared decision-making (43,7% of records), followed by the domain progress notes e.g. physicians’ documentation of patients’ dying process (36,2% of records).

Discussion: The developed data extraction tool allows analysing, if quality indicators and key recommendations on care in the dying phase are reflected within medical records. The tool can be used in general wards as well as in intensive care units, regardless of the hospital department and the primary disease of the deceased patient. As medical record analysis is limited to the information documented, it may not provide a complete picture of the actual care provided to patients.

Implication for research: The tool enables a structured retrospective analysis of the routine documentation in medical records and the extent to which recommendations and quality indicators regarding care in the dying phase are reflected therein. To gain a full understanding of the care provided to patients in this phase, it should be combined with other methods [2].

Funding: Innovationsfonds/Versorgungsforschung; 01VSF19033


References

1.
German Guideline Programme in Oncology (GGPO). Palliative care for patients with incurable cancer. Short version 2.2 – September 2020. AWMF-registration number 128/001OL. 2020. Verfügbar unter: https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Palliativmedizin/Version_2/GGPO_Palliative_Care_ShortVersion_2.2.pdf External link
2.
Kremeike K, Ullrich A, Schulz H, Rosendahl C, Boström K, Kaur S, Oubaid N, Plathe-Ignatz C, Leminski C, Hower K, Pfaff H, Hellmich M, Oechsle K, Voltz R. Dying in hospital in Germany - optimising care in the dying phase: study protocol for a multi-centre bottom-up intervention on ward level. BMC Palliat Care. 2022 May 6;21(1):67. DOI: 10.1186/s12904-022-00960-1 External link