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UK consensus project on quality in palliative day services: developing a quality indicator set using the RAND/UCLA appropriateness method
  1. Martin Dempster1,
  2. Noleen McCorry1,2,
  3. Sean O’Connor1,
  4. Kathy Armour3,
  5. Joanna Coast4,
  6. Joachim Cohen5,
  7. Michael Donnelly1,
  8. Anne Finucane6,
  9. Joan Fyvie2,
  10. Louise Jones7,
  11. George Kernohan8,
  12. Kathleen Leemans5,
  13. David Oxenham9 and
  14. Paul Perkins10
  1. 1Queen’s University Belfast
  2. 2Marie Curie, Belfast
  3. 3Marie Curie, West Midlands
  4. 4University of Bristol
  5. 5Vrije Universiteit, Brussels
  6. 6Marie Curie, Edinburgh
  7. 7University College London
  8. 8Ulster University
  9. 9County Durham and Darlington Foundation NHS Trust
  10. 10Leckhampton Court Hospice, Cheltenham


Introduction Evaluating quality of palliative day services is essential for assessing care across diverse settings, and for monitoring quality improvement approaches.

Aim To develop a set of quality indicators for assessment of all aspects (structure, process and outcome) of care in palliative day services.

Methods Using a modified version of the RAND/UCLA appropriateness method (Fitch et al., 2001), a multidisciplinary panel of 16 experts independently completed a survey rating the appropriateness of 182 potential quality indicators previously identified during a systematic evidence review. Panel members then attended a one day, face-to-face meeting where indicators were discussed and subsequently re-rated. Panel members were also asked to rate the feasibility and necessity of measuring each indicator.

Results 71 indicators classified as inappropriate during the survey were removed based on median appropriateness ratings and level of agreement. Following the panel discussions, a further 60 were removed based on appropriateness and feasibility ratings, level of agreement and assessment of necessity. Themes identified during the panel discussion and findings of the evidence review were used to translate the remaining 51 indicators into a final set of 27.

Conclusion The final indicator set included information on rationale and supporting evidence, methods of assessment, risk adjustment, and recommended performance levels. Further implementation work will test the suitability of this ‘toolkit’ for measurement and benchmarking. The final indicator set provides the basis for standardised assessment of quality across services, including care delivered in community and primary care settings.


  1. Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA: RAND Corporation; 2001.

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