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February 2007

Quality Partners-Quality Initiatives in Hospice

At the National Hospice Palliative Care Organization (NHPCO) Management and Leadership Conference, the new "Quality Partners" quality initiative was rolled out. Much like the quality indicators in home care that measure patient outcomes, there is a push to measure outcomes in hospice as well. Another driver for looking at quality in hospice is the proposed Conditions of Participation (CoP) that includes federal requirements for quality assessment and performance improvement that will be known as QAPI. The new conditions will require hospice programs to develop, implement and maintain an effective, ongoing, comprehensive and data-driven QAPI program that incorporates specific data elements linked to patient assessments and plans of care.

NHPCO put together a Quality Advisory Panel in 2004 looking at ways to respond to the growing concerns about the national quality developments. The goal was to come to an understanding that a national initiative was needed.

The Institute of Medicine (IOM) has identified ten components of quality, including:

1. Patient and Family Centered Care, which means providing care and services that are responsive to the needs and exceed the expectations of those patients and families we serve in the hospice community.

2. Ethical Behavior and Consumer Rights, in which we uphold the highest standards of ethical conduct and advocate for the rights of patients and their family caregivers.

3. Clinical Excellence and Safety, so that we ensure clinical excellence and promote safety through our standards of practice.

4. Inclusion and Access, to ensure all people, regardless of race, ethnicity, color, religion, gender, disability, sexual orientation, age, disease or other characteristics, have access to the same programs as everyone else.

5. Organizational Excellence and Accountability within our organizations that values collaboration and communication and ensures ethical business practices.

6. Workforce Excellence fosters a collaborative, interdisciplinary environment that promotes inclusion, individual accountability and workforce excellence through professional development, training and support to all staff and volunteers.

7. Adopting the NHPCO Standards of Practice for Hospice Programs and/or the National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care as the foundation for your hospice organization.

8. Ensuring compliance with all the applicable laws, regulations and professional standards of practice and implementing systems and processes that prevent fraud and abuse. 

9. Developing a qualified, diverse governance structure and senior leadership who share the responsibilities of fiscal and managerial oversight. 

10. Collecting, analyzing, and actively using performance measurement data to foster quality assessment and performance improvement in all areas of care and services. (Excerpted from NHPCO Newsline July 2006 and from Management Leadership Conference September 2006).

So what is Quality Partners? It is the national hospice quality initiative designed to help hospice providers take a complete look at their organization with the goal of improving the quality of care throughout. It is still a work in progress that will continue to evolve over the coming months and years ahead. Participants involved will learn from their peers, respond to new challenges and continually work toward improving the quality of care to patients and their families. Hospice is growing and there is no universal data collection tool, such as the OASIS, in home care. Quality Partners will provide opportunities for the development of self-assessment and data collection tools, performance measures and a forum for sharing ideas and best practices.

For a resource that reviews the various aspects of palliative care, going beyond theoretical information that advises clinicians on the most effective management, which can assist in better patient outcomes and improved quality of care,
click here.

Cyndi Rohret RN, BSN, CRNI, CHPN
Clinical Consultant, Briggs Corporation

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