Quality Indicators for Home-Based Palliative Care: A Systematic Review.

Abstract

The advantages of home-based palliative care (HPC) are becoming increasingly acknowledged, resulting in a growing demand for this care model. The quality indicators (QIs) required for HPC may differ in scope and focus from those used in other care settings. This review aimed to identify and integrate QIs for the provision of HPC. We searched PubMed, Medline, CINAHL, Cochrane Library, Web of Science and Embase databases to identify all articles on QIs for HPC. The QIs extracted from these articles were categorized by structure, process, or outcome, mapped to 8 care domains, and their methodological characteristics were evaluated. Fifteen articles were ultimately included, comprising 312 unique QIs. Among these, 45.5% were outcome indicators, 39.1% were process indicators. The most frequently addressed care domain were "Structure and Process of Care" (44.2%) and "Physical Aspects of Care" (28.8%), whereas the fewest QIs pertained to "Spiritual, Religious and Existential Aspects of Care" (2.2%) and "Cultural Aspects of Care" (1.6%). Methodological quality assessment varied considerably across the studies, with 7 articles rated as high quality. This study integrated QIs for HPC. The majority of identified QIs were outcome or process indicators. However, fewer addressed social, cultural, and spiritual care domains. Validation was also limited, as only a small proportion of these QIs met sufficient criteria for warrant further testing. Future research could consider expanding QIs related to cultural sensitivity, home telehealth regulations, and subjective experiences and preferences to facilitate a more thorough and reliable assessment to improve the quality assessment of HPC services.