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The Opportunity
Palliative care generally refers to patient and family-centered care that optimizes quality of life by anticipating, preventing, and alleviating suffering across the continuum of a patient’s illness. Historically, palliative care referred to treatment available to patients at home and enrolled in hospice. More recently, palliative care has become available to acutely ill patients and its meaning has evolved to encompass comprehensive care that may be provided along with disease-specific, life-prolonging treatment. End-of-life (EOL) care refers to comprehensive care for a life-limiting illness that meets the patient’s medical, physical, psychological, spiritual and social needs. Hospice care is a service delivery system that emphasizes symptom management without life-prolonging treatment, and is intended to enhance the quality of life for both patients with a limited life expectancy and their families.
Attention recently has been focused on increasing the quality and availability of hospice and palliative care services, both for acutely ill patients and those at EOL. Studies have found that palliative care programs across the trajectory of a patient’s illness, including EOL care can result in improved quality of care, including higher patient satisfaction, improved communication, fewer admissions to intensive care units, emergency departments and acute care hospitals, more referrals to hospice, and reduced costs.
The number of palliative care and EOL care programs has increased rapidly in recent years. Nonetheless, palliative care and EOL care services remain underutilized and more than one million people in the United States die each year of chronic and debilitating illnesses without receiving hospice services. A comprehensive set of performance metrics is needed to gauge our progress in these clinical areas.
In 2006, NQF endorsed a palliative care and hospice framework which provides a foundation for quality measurement and reporting systems in these areas. As part of this work, 38 preferred practices were endorsed for implementation by palliative care and hospice programs. The preferred practices were derived from the eight domains of quality palliative and hospice care as established by the National Consensus Project for Quality Palliative Care:
- structures and processes of care;
- physical aspects of care;
- psychological and psychiatric aspects of care;
- social aspects of care;
- spiritual, religious, and existential aspects of care;
- cultural aspects of care;
- care of the imminently dying patient; and
- ethical and legal aspects of care.
Prior to 2008, NQF endorsed nine national voluntary consensus standards for addressing symptom management and EOL care for cancer patients, including the National Hospice and Palliative Care Organization survey instrument, components of the Family Evaluation of Hospice Care, and measures addressing healthcare utilization at the EOL.
The current project will seek to endorse performance measures focusing on:
- assessment and management of relief of symptoms at EOL and for acutely ill patients (e.g., pain, dyspnea, weight loss, weakness, nausea, serious bowel problems, delirium and depression);
- patient- and family-centered palliative and hospice care that address psychosocial needs and care transitions; and
- patient, caregiver and family experiences of care.
About the Project
This project will begin in April 2011.
Objectives
NQF seeks to identify and endorse measures for public reporting and quality improvement addressing quality of care for patients receiving palliative and/or EOL care. Review of NQF-endorsed® standards relating to EOL care undergoing maintenance will also be conducted in this project.
NQF Process
Measures will be considered for NQF endorsement as national voluntary consensus standards based on the recommendations developed through NQF’s formal Consensus Development Process (CDP) (Version 1.8). This project involves the active participation of representation from across a broad spectrum of healthcare stakeholders and will be guided by a Steering Committee.
Funding
This project is funded by the Department of Health and Human Services.
Related NQF Work
Contact Information
For further information, contact Lindsey Tighe, MS, at 202-783-1300 or via e-mail at pmpalliative@qualityforum.org.
Notes:
1 National Quality Forum (NQF), A National Framework and Preferred Practices for Palliative and Hospice Care Quality, Washington, DC: NQF; 2006, p. VI.
2 Morrison SJ, Penrod JD, Cassel JB. Cost savings associated with US hospital palliative care consultation programs. Arch IM, 2008; 168(16): 1783-90.
3 White KR, Cochran CE, Patel UB. Hospital provision of end-of-life services, Med Care, 2002;40:17-25.
4 National Quality Forum (NQF), p. VI.
5 Gade G, Venohr I, Conner D, et al., Impact of an inpatient palliative care team: a randomized controlled trial, J Palliat Med, 2008;11(2):180-190.
6 Dudgeon D, Knott C, Eichholz M, et al., Palliative Care Integration Project (PCIP) quality improvement strategy evaluation, J Pain Symptom Manage, 2008: 35(6): 573-582.
7 Morrison RS, Dietrich J, et al, Palliative care consultation teams cut hospital costs for Medicaid beneficiaries, Health Affair, March 2011; 30(3) 454-463.
8 Jennings B, Ryndes T, D’Onofrio C, et.al., Access to hospice care – Expanding boundaries, overcoming barriers, Hastings Cent Rep, 2003;Suppl(March-April):S3-S7, S-9-S13, S15-S21.
