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.