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Knowledge Point Articles   

December 2006

Outcome Measurements in Hospice

The proposed Conditions of Participation (CoPs) are going to be geared toward measuring performance as well as measuring your operations. One of the requirements the proposed CoPs are focusing on is Quality Assessment Performance Improvement (QAPI). It will be a hospice-wide, data-driven quality improvement assessment and performance improvement program with measurement, analysis and tracking of quality indicators including adverse patient events and measures of processes of care, hospice services and operations. 

Next, they will be looking at comprehensive assessments that integrate the various disciplines and family members as well. The CoP’s will include patient outcome measures and will link with the care plan and the QAPI process. Your team care plan should be integrated, intervention-specific and driven by the comprehensive assessment. For example, your hospice agency uses pain management as a quality measure. Your hospice’s goal is that the patient will be comfortable within 48 hours of admission. Then your care plan can be implemented stating you will follow-up and monitor pain control within 48-72 hours. Next you can measure that outcome to see if the patient’s pain was controlled and look at the percentage of your patients that had their pain controlled within 48 hours of admission. 

One of the basics for the QAPI process is an organizational culture of quality. It is important for the organization to understand quality and what it means to them. Responsibilities and clear cut performance measures should be defined throughout staff members. There needs to be a plan for data collection and management. You have a solid base right now, but you need to develop what you have in place and build on it  Make sure you understand what you have to work with and what currently works for you, and identify any “gaps” you may have in the process, people or system. Work with your peers to combine best practice(s). 

When you begin to look at your organization, look at your operations. Review the various programs and structure. Look at the types of patients you have and review the staffing models, care planning, use of volunteers and bereavement process  You will review your financials to see what your costs are and the revenue generated. Then look at the clinical outcomes, such as the National Hospice and Palliative Care Organization (NHPCO) end-result outcomes. The selected hospice care measures, such as traditional falls, infection control and medication errors, can also be included in your monitoring of the care delivered. It is very important to evaluate service/process quality, such as after hour calls and staff’s responsiveness, because it is linked to family satisfaction with the care delivered. The agency satisfaction surveys given to your internal employees and board of directors along with the external patient/family, community and referral sources will help you know how you are doing.

The current standard measures that you should be collecting now are utilizing NHPCO protocols for end result outcomes, which are:

• Comfort within 48 hours of admission
• Unwanted hospitalizations and/or CPR

Also included if necessary are:

• After hours responsiveness
• Caregiver confidence: how comfortable was the caregiver providing care to their loved one
• Emotional support around death (before and after): 13 month bereavement survey should be done
• Timeliness of referral

So when you start to re-evaluate your hospice program, selecting outcome measures should:

• Be clearly defined
• Be consistently measured/collected
• Show that variations in data highlight the variations in practice
• Address core hospice goals and hospice priorities 
• Use national standard measures where possible

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