Indicators measure quality of hospice, palliative care providers

Two organizations of professionals who provide palliative and hospice care developed a series of indicators to gauge the quality of care that patients receive.

Measuring What Matters is a joint project of the American Academy of Hospice and Palliative Medicine and the Hospice & Palliative Nurses Association.

“Patients deserve to get the very best palliative and hospice care no matter where they live or receive the care, and our goal was to choose the measures that should be used to ensure that is the case,” says Joseph D. Rotella, MD, MBA, HMDC, FAAHPM, incoming chief medical officer of the American Academy of Hospice and Palliative Medicine and co-chair of the Measuring What Matters Clinical User Panel.

The panel included experts in the field who used input from patients, their families, physicians, nurses, social workers, grief counselors, and other providers of palliative care. The 10 measures were selected from 75 indicators largely based on what is important to patients and families.

The measures are intended for use by hospice and palliative care providers for self-assessment and quality improvement, Rotella says. He suggests that case managers might want to add the measures to their organization’s quality improvement programs.

The following are the 10 Measures that Matter:

1. Palliative care and hospice patients receive a comprehensive assessment (physical, psychological, social, spiritual, and functional) soon after admission.
2. Seriously ill palliative care and hospice patients are screened for pain, shortness of breath, nausea, and constipation during the admission visit.
3. Seriously ill palliative care and hospice patients who screen positive for at least moderate pain receive treatment (medication or other) within 24 hours.
4. Patients with advanced or life-threatening illnesses are screened for shortness of breath and, if positive to at least a moderate degree, have a plan to manage it.
5. Seriously ill palliative care and hospice patients have a documented discussion regarding emotional needs.
6. Hospice patients have a documented discussion of spiritual concerns or a preference not to discuss them.
7. Seriously ill palliative care and hospice patients have documentation of the surrogate decision-maker’s name (such as the person who has healthcare power of attorney) and contact information or absence of a surrogate.
8. Seriously ill palliative care and hospice patients have documentation of their preferences for life-sustaining treatments.
9. Vulnerable elders with documented preferences to withhold or withdraw life-sustaining treatments have their preferences followed.
10. Palliative care and hospice patients or their families are asked about their experience of care using a relevant survey.