Development and practical test of quality indicators for palliative care in patients with chronic heart failure

Yasuhiro Hamatani, Yasuko Takada, Yoshihiro Miyamoto, Yukie Kawano, Yuta Anchi, Tatsuhiro Shibata, Atsushi Suzuki, Mitsunori Nishikawa, Hiroto Ito, Masashi Kato, Tsuyoshi Shiga, Yoshihiro Fukumoto, Chisato Izumi, Satoshi Yasuda, Hisao Ogawa, Yasuo Sugano, Toshihisa Anzai

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


Background: Palliative care is highly relevant for patients with heart failure (HF), and there is a need for quantitative information on quality of care. Accordingly, this study aimed to develop a set of quality indicators (QIs) for palliative care of HF patients, and to conduct a practical pilot measurement of the proposed QIs in clinical practice. Methods and Results: We used a modified Delphi technique, a consensus method that involves a comprehensive literature review, face-to-face multidisciplinary panel meeting, and anonymous rating in 2 rounds. A 15-member multidisciplinary expert panel individually rated each potential indicator on a scale of 1 (lowest) to 9 (highest) for appropriateness. All indicators receiving a median score ≥7 without significant disagreement were included in the final set of QIs. Through the consensus-building process, 35 QIs were proposed for palliative care in HF patients. Practical measurement in HF patients (n=131) from 3 teaching hospitals revealed that all of the proposed QIs could be obtained retrospectively from medical records, and the following QIs had low performance (<10%): “Intervention by multidisciplinary team”, “Opioid therapy for patients with refractory dyspnea”, and “Screening for psychological symptoms”. Conclusions: The first set of QIs for palliative care of HF patients was developed and could clarify quantitative information and might improve the quality of care.

Original languageEnglish
Pages (from-to)584-591
Number of pages8
JournalCirculation Journal
Issue number4
Publication statusPublished - 2020


  • Heart failure
  • Palliative care
  • Quality indicators


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