{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:10:31Z","timestamp":1787019031282,"version":"build-2736575974"},"reference-count":37,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T00:00:00Z","timestamp":1652054400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["844001406"],"award-info":[{"award-number":["844001406"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:p>Background: National clinical guidelines have been developed internationally to reduce variations in clinical practices and promote the quality of palliative care. In The Netherlands, there is considerable variability in the organisation and care processes of inpatient palliative care, with three types of hospices \u2013 Volunteer-Driven Hospices (VDH), Stand-Alone Hospices (SAH), and nursing home Hospice Units (HU). Aim: This study aims to examine clinical practices in palliative care through different hospice types and identify variations in care. Methods: Retrospective cohort study utilising clinical documentation review, including patients who received inpatient palliative care at 51 different hospices and died in 2017 or 2018. Care provision for each patient for the management of pain, delirium and palliative sedation were analysed according to the Dutch national guidelines. Results: 412 patients were included: 112 patients who received treatment for pain, 53 for delirium, and 116 patients underwent palliative sedation therapy. Care was provided in accordance with guidelines for pain in 32%, 61% and 47% (P = .047), delirium in 29%, 78% and 79% (P = .0016), and palliative sedation in 35%, 63% and 42% (P = .067) of patients who received care in VDHs, SAHs and HUs respectively. When all clinical practices were considered, patient care was conducted according to the guidelines for 33% of patients in VDHs, 65% in SAHs, and 50% in HUs (P &lt; .001). Conclusions: The data demonstrate that care practices are not standardised throughout Dutch hospices and exhibit significant variations between type of hospice.<\/jats:p>","DOI":"10.1177\/10499091221100804","type":"journal-article","created":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T05:36:48Z","timestamp":1652074608000},"page":"87-95","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Variations in Clinical Practice: Assessing Clinical Care Processes According to Clinical Guidelines in a National Cohort of Hospice Patients"],"prefix":"10.1177","volume":"40","author":[{"given":"Everlien","family":"de Graaf","sequence":"first","affiliation":[{"name":"Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6878-9197","authenticated-orcid":false,"given":"Matthew","family":"Grant","sequence":"additional","affiliation":[{"name":"Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederieke","family":"van de Baan","sequence":"additional","affiliation":[{"name":"Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marijke","family":"Ausems","sequence":"additional","affiliation":[{"name":"The Dutch College of General Practitioners, Palliative Care Physician, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathelijne","family":"Verboeket-Crul","sequence":"additional","affiliation":[{"name":"Academic Hospice Demeter, De Bilt, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Leget","sequence":"additional","affiliation":[{"name":"University of Humanistic Studies, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskia","family":"Teunissen","sequence":"additional","affiliation":[{"name":"Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,5,9]]},"reference":[{"issue":"5","key":"bibr1-10499091221100804","first-page":"435","volume":"40","author":"Grol R","year":"1995","journal-title":"J Fam Pract"},{"key":"bibr2-10499091221100804","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2008.028043"},{"issue":"3","key":"bibr3-10499091221100804","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1136\/bmjspcare-2016-001159","volume":"7","author":"Abarshi E","year":"2017","journal-title":"BMJ Support Palliat Care"},{"key":"bibr4-10499091221100804","volume-title":"Netherlands quality framework for palliative care","author":"Palliactief IKN","year":"2017"},{"key":"bibr5-10499091221100804","doi-asserted-by":"publisher","DOI":"10.1016\/j.survophthal.2004.02.010"},{"key":"bibr6-10499091221100804","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198905043201810"},{"key":"bibr7-10499091221100804","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.13.2555"},{"key":"bibr8-10499091221100804","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182922a17"},{"key":"bibr9-10499091221100804","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1999.17.1.361"},{"key":"bibr10-10499091221100804","doi-asserted-by":"publisher","DOI":"10.3109\/09540269409025239"},{"issue":"1","key":"bibr11-10499091221100804","volume":"7","author":"Ibn El Haj H","year":"2013","journal-title":"International Journal for Quality Research"},{"key":"bibr12-10499091221100804","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181c5887c"},{"key":"bibr13-10499091221100804","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2007.02.033"},{"key":"bibr14-10499091221100804","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2016-001200"},{"key":"bibr15-10499091221100804","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780195158090.001.0001","volume-title":"An introduction to quality assurance in health care","author":"Donabedian A","year":"2002"},{"key":"bibr16-10499091221100804","doi-asserted-by":"publisher","DOI":"10.1163\/092902707X185451"},{"key":"bibr17-10499091221100804","volume-title":"General Principals of Palliative Care; 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