Palliative care at home: quality measurement and organizational drivers: evidences from Italy

The aim of this paper is to measure the quality level of care provided by Home palliative units delivering specialized care in Italy and to determine their main drivers among process/structure characteristics. Data were collected via e-survey from a sample of 118 Home palliative care units (nearly 40,000 patients cared in 2013), representing 66% of Home palliative care units active in 2013, within an Institutional initiative aimed at monitoring the practices used in palliative care. Respondents were given a list of 38 good practices and were asked to identify those applied in their units on a daily basis. The dichotomous Rasch Model was used to identify a unidimensional construct defining units’ quality, such as the propensity to deliver high quality care. Linear and quantile regression models were used to assess the relationship of the Rasch quality scores with units’ structural/process characteristics. The results show large differences of quality levels among units and among practices in terms of application’s difficulty. The main quality predictors consist in the collaboration with Hospitals/Hospices in the same catchment area, the amount of specialized nurses in the unit and the additional delivery of basic palliative care. These findings demonstrate a hierarchy of the practices’ difficulty and the principal drivers that may favor future challenges, clearly illustrating a roadmap which maximizes the propensity for successful future implementations.