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Implementing quality indicators into specialized palliative care services at home and in hospitals in Flanders, Belgium

A mixed-method process evaluation of the implementation making use of the RE-AIM framework


04-2014 to 06-2018

Abstract project


Quality of palliative care is of interest to everyone receiving or delivering it. Quality indicators are defined as measurable aspects of care referring to structure, process, or outcome and are mostly measured on individual level but interpreted as aggregated, e.g. at service level. Quality indicator scores can be used to evaluate which aspects of the care are going well and which are not going and have room for improvement. In Belgium, a comprehensive quality indicator and accompanying measurement procedure were developed and tested for face-validity, feasibility and usefulness.


To implement the quality indicator set into the specialized palliative care services at home and in hospitals and evaluate this implementation process


For the actual implementation, specialized palliative care services voluntarily apply for using the indicator set in order to continuously evaluate and improve their care. The teams independently measure quality of care within their service making use of the indicators and questionnaires. The research group analyses the data and provide the teams with an individual feedback report. Teams measure twice a year making use of a cross sectional inclusion method.

During the implementation period a process evaluation takes place via quantitative and qualitative research methods. Statistical analyses and evaluation of the indicators and indicator scores are combined with interviews and implementation research. The latter will take place making use of the RE-AIM framework. We will analyze the number of teams participating, the number of respondents reached, the actual implementation within the different teams and the barriers and facilitators for implementation.

Furthermore an automatized registration tool will be developed together with an automatic data processing system in cooperation with the services.

At the end of the study all results will be reformed into policy guidelines that will be presented in a report for policy makers.

For more information in Dutch text on the current implementation of the quality indicators into the Flemish palliative care services, please visit


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Project group

Postdoctoral researcher: Kathleen Leemans
Promotor: Joachim Cohen
Project group member: Lieve Van den Block
Project group member: Robert Vander Stichele


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Federatie Palliatieve Zorg Vlaanderen