Palliative Care Metrics David E. Weissman, MD Palliative Care Center Professor Emeritus, Medical College of Wisconsin Center to Advance Palliative Care Academy Health 2010 Annual Research Meeting Academy Health 2010 Annual Research Meeting The Dilemma • Current research does not yet provide a sufficient evidence base to support links between structure‐ evidence base to support links between structure process‐outcomes for key palliative care domains: – Quality of life, family burden, spiritual well being, y y p g bereavement, continuity, pain and other symptoms • Quality measures are becoming the foundation for healthcare reform – Required by payors, regulatory bodies, certifying agencies • Pay for performance, Public reporting, CQI P f f P bli ti CQI • Palliative care cannot afford to ignore quality What makes a good measure? • Uniform – Core set for all hospitals • Balance utility with data collection ease Based on best available evidence • Based on best available evidence – Primarily structure and process measures – Select outcome measures Select outcome measures • Allows comparisons across institutions to guide programmatic growth ensure compliance with best programmatic growth, ensure compliance with best practices, and explore quality –N Not measures of quality because not (yet) linked to f li b ( ) li k d outcomes Metric Domains for Palliative Care Programs • Structural Measures – What elements must be included to be a Pall Care Program? • Operational Data – What p patients are being g seen? • Clinical / Customer – Am I improving the clinical care of patients? • Symptom assessment scores, psychosocial assessment scores – Am I meeting g the needs of ppatients and families? • Satisfaction survey data: patient, family, referring clinician • Financial – Is my program fiscally responsible? Structural Metrics • Wh What must a hospital h i l have h in i place l to be b considered id d a “palliative care program”? –S Specific ifi structural t t l elements l t necessary for f sustainable t i bl highhi h quality hospital palliative care programs – Developed p byy consensus panels p of PCLC experts, p , CAPC staff,, and CAPC consultants. – Interdisciplinary representation from academic and community hospitals, single hospitals and large health care systems, and from programs coordinated by hospice agencies and hospitals • Operationalize NQF Framework – 38 “preferred f d practices” i in i Hospice i andd Palliative lli i Care Weissman & Meier, J Palliat Med, 2008 Structural Metrics • 12 domains containing “Must Have” and “Should Have” recommendations – Program administration, Service types, Availability, Staffing, Measurement, QI, Marketing, Education, B Bereavement t Services, S i Patient P ti t identification, id tifi ti Continuity C ti it off care, Staff Wellness • St Starting ti point i t for f strategic t t i planning l i for f existing i ti programs and template for programmatic d l development t for f hospitals h it l in i planning l i phase. h Weissman & Meier, J Palliat Med, 2008 CAPC Operational p Metrics: Consultation Programs & Inpatient Units • Operational metrics required to assist programs in ensuring quality quality, sustainability sustainability, and growth • Operational metrics required to allow programs to compare their th i service i utilization tili ti to t similar i il programs throughout the country Weissman, Meier, & Spragens J Palliat Med, 2008 Weissman & Meier, J Palliat Med, 2009 Operational Metrics • Key data d ffor programs to track k their h i patients: i – – – – – – – – – Patient ID# Patient age, sex, race/ethnicity C Consultation diagnosis l i di i Referring service and/or referring physician Date of hospital admission Date of hospital admission Date of hospital discharge Date of consultation Disposition: inpatient death vs. discharge Hospice discharges Clinical and Customer Metrics • Measurement domains – Clinical Cli i l Metrics M ti • Assessment and management of physical/psychological/spiritual sy pto s symptoms • Establishment of patient-centered goals of care • Support to patient and family caregivers • Management of transitions across care sites – Customer satisfaction metrics • Patient/family satisfaction • Referring physician satisfaction Weissman, Morrison, Meier, J Palliat Med, 2009 Data Collection (Clinical Care and Satisfaction) • Sample – most programs cannot afford to collect data on everybody • Clinical data elements – Chart audit dependent on programmatic/administrative needs • 25% random sample of patients for new programs • 10 patients per quarter may be sufficient for established programs • Satisfaction – New programs – sample families every 3-6 months and all referring clinicians over a two week period for each quarter of the year – Established programs – every 2 years or following major changes or initiatives in the clinical program Financial Metrics • No current consensus, but common measures include: – Cost/day: pre/post consultation – Billing revenue Billing revenue – Length of stay – Philanthropy National Palliative Care Registry • https://registry.capc.org/ • C Centralized t li d data d t repository it off program operational ti l metrics developed by CAPC and the National Palliative Care Research Center • Provides operational reports for individual programs • Provides historical comparisons for individual programs • Comparative reporting across similar institutions available in future • Currently free for new registrants References • W Weissman DE, Meier DE: Operational features for hospital i DE M i DE O ti lf t f h it l palliative care programs: consensus recommendations. J Palliat Med 11:1189‐1194, 2008 • Weissman DE, Meier DE: Center to advance palliative care inpatient unit operational metrics: consensus , recommendations. J Palliat Med 12:21‐25, 2009 • Weissman DE, Meier DE, Spragens LH: Center to Advance Palliative Care palliative care consultation service metrics: consensus recommendations J Palliat Med 11:1294‐1298, consensus recommendations. J Palliat Med 11:1294‐1298 2008 • Weissman DE, Morrison S, Meier DE. Center to Advance P lli ti C Palliative Care Palliative Care Clinical Care and Customer P lli ti C Cli i l C dC t Satisfaction Metrics: consensus recommendations. J Palliat Med, 13: 174‐179.