UK consensus project on quality in palliative day services: developing a quality indicator set using the RAND/UCLA appropriateness method

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.

Reference

• Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA: RAND Corporation; 2001. http://www.rand.org/pubs/monograph_reports/MR1269

Es teatro vuestra oración: Santa Teresa’s performed confession in Juan Mayorga’s La lengua en pedazos

Juan Mayorga’s La Lengua en Pedazos (2010) strikes at the heart of the compositional circumstances of St Teresa's Libro de la Vida– staging, and arguably heightening the origins of her rhetorical strategies, the sense of awareness of readership and potential censure we encounter within the Libro de la Vida. His inquisitor refuses to be complicit in the tacit agreement that the word spoken in the theatrical space can conjure new realities –insistent on underscoring the textual origin of the visions painfully and partially offered up for his and our scrutiny. I will suggest that the persistent undertow towards a meta-commentary on the unmaking and remaking of the autobiographical text creates an unresolved tension between Teresa’s eloquent ability to take the spectator to a place beyond language, and our awareness that we are in the presence of a consummate performer, the textual source for the script itself produced with a supreme awareness of audience scrutiny. The play reflects ongoing lines of inquiry in our evolving understanding of the cultural production of Teresa and other holy women of the Early Modern period.