Quality Measures for Palliative Care

2020 ◽  
pp. 99-114
Author(s):  
Tamara Vesel ◽  
Jatin Dave
Keyword(s):  
Palliative Care ◽  
Quality Measures

Quality of end-of-life cancer care at minority-serving US cancer centers: A retrospective study of Medicare claims data.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6507-6507
Author(s):  
Garrett Wasp ◽  
Shama S Alam ◽  
Gabriel A. Brooks ◽  
Inas S Khayal ◽  
Nirav S. Kapadia ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Quality Measures ◽  
Specific Rate ◽  
Cancer Centers ◽  
Icu Admission ◽  
Hospice Referral ◽  
Life Sustaining Treatment ◽  
Eol Care ◽  
White Patients

6507 Background: Higher EOL treatment intensity is burdensome and has been defined as low-quality care. We explored cancer centers’ EOL quality outcomes among minority and white patients and evaluated whether minority-serving cancer centers had systematically lower EOL quality. Methods: We conducted a retrospective cohort study of Medicare beneficiaries with poor-prognosis cancers who died between April 1, 2016 and December 31 2016. We attributed patients’ EOL treatment to the cancer center where they received the preponderance of inpatient services during the last 6 months of life. We then compared age-sex-comorbidity adjusted center-level measures of EOL care (EOL chemotherapy, emergency department (ED) use, intensive care unit (ICU) admission, hospice use, life-sustaining treatment use, palliative care, and advance care planning) between minority (black, Hispanic, Asian, other) and non-Hispanic white (white) patients within the same center and across centers, grouped by concentration of minorities served (low: < 15%, medium 15-30%, and high > 30%). Results: Among 126,434 patients, 10,006 (21.4% minority) received treatment at one of 53 National Cancer Institute-designated and/or National Comprehensive Cancer Network-affiliated cancer centers. Only 4/8 quality measures had sufficient sample size to calculate a minority-specific rate for ≥10 centers. Those measures showed high within-center correlation for minority and white patients (ICU admission: r = 0.79,p < 0.001; no hospice referral: r = 0.70,p < 0.0001; life sustaining treatment: r = 0.73,p = 0.004; and palliative care: r = 0.78,p < 0.0001), but the mean adjusted rate for minority versus white patients was significantly worse for two measures: no hospice referral (40.2% v. 37.2%; p < 0.02) and life-sustaining treatments (21.8% v. 19.4%; p < 0.02). When grouped by concentration of minorities served (low/medium/high), 5/8 measures showed systematically lower quality as the concentration of minorities increased: more than 1 ED visit (6.0/8.5/7.7%; p = 0.002), ICU admission (29.1/29.7/35.1%; p = 0.0004), no hospice referral (34.3/38.7/36.8% (p = 0.005), and life sustaining treatments (14.8/16.7/17.9%; p = 0.005). Conclusions: There were systematic differences in end-of-life quality measures across US cancer centers. For many measures, quality was lower at centers that served a greater concentration of minorities. However, EOL care quality for minority and white patients was similar for most but not all measures within any given center.

scholarly journals Re-Engineering a Small Oncology Practice for Quality Using the ASCO Quality Oncology Practice Initiative

2013 ◽  
Vol 9 (3) ◽  
pp. 169-170 ◽  
Author(s):  
Carolyn B. Hendricks
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
Quality Measures ◽  
Future Challenges ◽  
Oncology Practice

The field of quality improvement is expanding rapidly, and small oncology practices need to adapt and rise to future challenges. Additional quality measures from ASCO and other organizations will likely focus on palliative care, the Top Five, and electronic measures.

scholarly journals Quality Measures in Surgical Palliative Care

2019 ◽  
Vol 269 (4) ◽  
pp. 607-609 ◽  
Author(s):  
Katherine C. Lee ◽  
Steven S. Senglaub ◽  
Anne M. Walling ◽  
Anne C. Mosenthal ◽  
Zara Cooper
Keyword(s):  
Palliative Care ◽  
Quality Measures

Toward proven and prioritized quality measures: Which ASCO QOPI and other supportive care measures associate with improved quality of life (QOL)?

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 165-165
Author(s):  
Arif Kamal ◽  
Janet Bull ◽  
Amy Pickar Abernethy
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Supportive Care ◽  
Cancer Patients ◽  
Clinical Care ◽  
Performance Status ◽  
Quality Measures ◽  
Well Being ◽  
Care Quality ◽  
The Impact

165 Background: An expanding array of quality measures, including the Quality Oncology Practice Initiative (QOPI) metrics, is being developed for oncology. To date, evidence demonstrating the impact of each metric on outcomes, ultimately aiding in prioritization of individual measures, remains immature. We investigated the relationship between conformance with quality measures and higher patient QOL among cancer patients receiving palliative care. Methods: A comprehensive systematic review of PUBMED and the gray literature (1995-2012) identifed all described supportive care quality measures. Patients receiving palliative care in 4 community-based programs were entered into a longitudinal quality registry; analyses focused on cancer patients registered between 6/08-10/11. To find predictors of higher QOL, conformance cohorts were examined for demographic variables, performance status (measured by palliative performance scale, PPS) and provider estimation of prognosis and included in univariate and multivariate regression. Results: The systematic review yielded 303 quality measures. Of these, 18 measures, representing components of the ASCO QOPI, Hospice PEACE, and Cancer-ASSIST measure sets, were evaluable using registry data. 460 cancer patients were included. 60% of patients had weeks to 6 months expected prognosis. Among QOPI measures, conformance with two measures was significantly associated with better QOL: constipation assessment at time of narcotic prescription and emotional well-being assessment (both p<0.05). Other significant findings were conformance with screening of symptoms at first visit (p=0.017), timely treatment for uncontrolled dyspnea (p=0.005), and assessment of fatigue (p=0.007). In a multivariate model predicting higher QOL, measures involving emotional well-being assessment (OR 1.60; p=0.026) and screening of symptoms (OR 1.74, p=0.008) remained significant. Conclusions: Clinical care that conforms to quality measures reflecting regular symptom and emotional assessment is significantly associated with better patient experiences (QOL) and should be prioritized in quality assessment efforts.

What type of feedback to clinicians best improves conformance to supportive care quality measures?

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 102-102
Author(s):  
Arif Kamal ◽  
Amy Pickar Abernethy ◽  
Janet Bull ◽  
Jonathan Nicolla ◽  
Joseph Kelly ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
Supportive Care ◽  
Symptom Assessment ◽  
Quality Measures ◽  
Care Quality ◽  
Quality Data ◽  
Improvement Project ◽  
Edmonton Symptom Assessment Scale ◽  
Comparative Feedback

102 Background: Supportive care is under-addressed in oncology and an important area for quality improvement. Regular, directed feedback is an important component of effective quality management. What type of feedback yields the highest conformance to supportive care measures? Methods: Within the Carolinas Palliative Care Consortium, we conducted a series of three PDSA cycles, each one month-long, to evaluate various types of clinician-directed feedback on conformance to two supportive care measures. We collected data using a web-based, mobile health platform called QDACT-PC (Quality Data Collection Tool for Palliative Care). Every four weeks, feedback to clinicians on performance was changed in a stepwise fashion, from “no feedback” to “personal feedback” to “comparative feedback” (personal conformance compared to the rest of the Consortium). We monitored weekly changes to conformance to two quality measures: documentation of timely management of constipation and dyspnea. To meet the measures, symptoms with intensity of >3/10 on the Edmonton Symptom Assessment Scale required documentation of intervention within 24 hours. Conformance rates were calculated and compared to a historical baseline. Results: 23 providers participated in this quality improvement project, which spanned 465 patient encounters across 104 unique patients. Baseline data generated from 3/2008-10/2011 demonstrated baseline conformance to the dyspnea and constipation measures at 6% (27/457) and 4% (14/398), respectively. After addition of an electronic, prospective quality monitoring system alone (QDACT-PC), conformance increased to 93% (42/45) and 92% (23/25), respectively. With personalized, weekly feedback, these rates increased to 94% for dyspnea and 100% for constipation. Feedback comparing personal performance to the average of the rest of the Consortium further increased this to 100% for both. Conclusions: Regular, weekly feedback on performance increases conformance to supportive care quality measures. Adding comparative feedback versus other peers solidifies this effect. Duration of the effect is being evaluated.

498: PALLIATIVE CARE CONSULTATION IS ASSOCIATED WITH ADHERENCE TO ICU PALLIATIVE CARE QUALITY MEASURES

2018 ◽  
Vol 46 (1) ◽  
pp. 234-234
Author(s):  
Joshua Lee ◽  
Nicholas Wysham ◽  
Steven Wolf ◽  
Mary-Ruth Pupa ◽  
Arif Kamal
Keyword(s):  
Palliative Care ◽  
Quality Measures ◽  
Care Quality ◽  
Palliative Care Consultation ◽  
Care Consultation

Proposed quality measures for palliative care in the critically ill: A consensus from the Robert Wood Johnson Foundation Critical Care Workgroup

2006 ◽  
Vol 34 (Suppl) ◽  
pp. S404-S411 ◽  
Author(s):  
Richard A. Mularski ◽  
J Randall Curtis ◽  
J Andrew Billings ◽  
Robert Burt ◽  
Ira Byock ◽  
...  
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
Critically Ill ◽  
Quality Measures ◽  
Robert Wood Johnson Foundation

The PEACE Project: Identification of Quality Measures for Hospice and Palliative Care

2010 ◽  
Vol 13 (12) ◽  
pp. 1451-1459 ◽  
Author(s):  
Anna P. Schenck ◽  
Franziska S. Rokoske ◽  
Danielle D. Durham ◽  
John G. Cagle ◽  
Laura C. Hanson
Keyword(s):  
Palliative Care ◽  
Quality Measures ◽  
Hospice And Palliative Care

Differential impact of inpatient and outpatient palliative care on end-of-life outcomes in hospitalized patients with cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24069-e24069
Author(s):  
Arielle R. Urman ◽  
Mary K. Buss ◽  
Robert J. Besaw ◽  
Kathleen A. Lee ◽  
Jonathan C. Yeh
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Statistical Tests ◽  
Quality Measures ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Fiscal Year ◽  
Do Not Resuscitate ◽  
Oncology Unit

e24069 Background: Palliative care (PC) improves outcomes for patients with advanced cancer, and current ASCO guidelines recommend early outpatient referral. However, recent data show that PC teams at many cancer centers see more inpatient consults than outpatient visits; the comparative impact of inpatient versus outpatient PC is not well-described. For this reason, we conducted a retrospective cohort study of hospitalized cancer patients to quantify exposure to inpatient/outpatient PC, and to describe associations between PC exposure and end-of-life (EOL) quality measures including hospice utilization, advance care planning (ACP), and intensity of care. Methods: We identified all patients admitted to one cancer center’s inpatient oncology unit during a fiscal year (10/1/2017 - 9/30/2018). Demographics, admission statistics, inpatient/outpatient PC visits, and EOL outcomes were abstracted from the electronic medical record. Deceased patients were identified through chart review and public obituaries. Results were summarized by descriptive statistics, and standard statistical tests were used to evaluate associations between PC exposure and EOL outcomes. Results: 842 patients were hospitalized in one year. 522 patients died by the study end-date of 10/1/2020 and were included in analysis. 50% of deceased patients had any PC exposure prior to death, but only 21% had an outpatient PC visit. Patients seen by PC were younger at time of death (median: 67 vs 72 years; p < .001) and more likely to be female (52% vs 42%; p = .03). Compared to patients never seen by PC, patients with any PC exposure were significantly more likely to enroll in hospice (78% vs 44%; p < .0001), have do-not-resuscitate status (87% vs 55%; p < .0001), have scanned ACP documents (53% vs 31%; p < .0001), and die at home or inpatient hospice instead of in the hospital (67% vs 40%; p < .01). PC exposure was not associated with differences in 30-day re-admissions, systemic cancer therapy in the last 14 days of life, or intensive care (ICU) utilization in the last 30 days of life. Notably, PC exposure was associated with longer hospital length-of-stay (LOS) (8.4 vs 7.0 days), but this association was reversed for patients seen by outpatient PC versus all others (6.3 vs 8.3 days; p < .01). Patients seen by outpatient PC also had longer hospice LOS (46.5 vs 27.1 days; p < .01) and less EOL ICU use (6% vs 15%; p < .05) compared to all others. Conclusions: In this large retrospective study of hospitalized cancer patients, PC exposure was associated with significant improvements in multiple EOL quality measures. The subset of patients seen by outpatient PC experienced additional benefits, including shorter hospital LOS, longer hospice LOS, and less EOL ICU utilization. These findings point to differential effects between inpatient and outpatient PC, underscoring the importance of early, longitudinal PC involvement.

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