• Robrecht De Schreye, Tinne Smets, Luc Deliens, Lieven Annemans, Birgit Gielen, and Joachim Cohen.
• End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels and Ghent, Ghent, Belgium. Electronic address: rdeschre@vub.ac.be.
• J Pain Symptom Manage. 2018 Oct 1; 56 (4): 541-550.e6.

ContextLarge-scale evaluations of the quality of end-of-life care in people with chronic obstructive pulmonary disease (COPD) are lacking.ObjectivesBy means of a validated set of quality indicators (QIs), this study aimed to 1) assess appropriateness of end-of-life care in people dying from COPD; 2) examine variation between care regions; 3) establish performance standards.MethodsWe conducted a retrospective observational study of all deaths from COPD (ICD-10 codes J41-J44) in 2012 in Belgium, using data from administrative population-level databases. QI scores were risk-adjusted for comparison between care regions.ResultsA total of 4231 people died from COPD. During the last 30 days of life, 60% was admitted to hospital and 11.8% received specialized palliative care. Large regional variation was found in specialized palliative care use (4.0%-32.0%) and diagnostic testing in the last 30 days of life (44.0%-69.7%). Based on best performing quartile scores, relative standards were set (e.g., ≤54.9% for diagnostic testing).ConclusionOur study found indications of inappropriate end-of-life care in people with COPD, such as high percentages of diagnostic testing and hospital admissions and low proportions receiving specialized palliative care. Risk-adjusted variation between regions was high for several QIs, indicating the usefulness of relative performance standards to improve quality of end-of-life COPD care.Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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