THE PALLIATIVE CARE MEASURE MENU

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180 METRICS FOUND

Metrics that meet the criteria specified in the Filters section.

Domain Metric Type Source Original Population NCP Ref Metric or Quality Indicator Add
Gen Structures / Processes Structure NQF PP PC patients NCP 1.2 Policies/procedures are in place that ensure that on transfer between healthcare settings, there is timely and thorough communication of the patient’s goals, preferences, values and clinical information Add     
Gen Structures / Processes Structure NQF PP PC patients NCP 1.3 Patients and families have access to palliative care expertise and staff 24 hours a day 7 days a week Add     
Gen Structures / Processes Structure NQF PP PC patients NCP 1.3 In rural areas where accessing specialized care is difficult, organizations should institute telehealth and telemedicine communications Add     
Gen Structures / Processes Structure NQF PP PC patients NCP 1.3 Palliative care is provided by an interdisciplinary team Add     
Gen Structures / Processes Structure NCP PC patients NCP 1.4 Presence of policies and procedures that outline the program's responsibilities to its volunteers Add     
Gen Structures / Processes Structure NCP PC patients NCP 1.4 An appropriately educated and experienced professional team member screens, educates, coordinates and supervises volunteers Add     
Gen Structures / Processes Structure NCP PC patients NCP 1.4 For programs utilizing volunteers, policies and procedures are in place to ensure safe, quality volunteer programs including: recruitment, screening (including background checks), training, job descriptions and role clarification, work practices, support, supervision, and performance evaluation Add     
Gen Structures / Processes Structure NQF PP PC patients NCP 1.5 Support for education and training is available to the interdisciplinary team. Add     
Gen Structures / Processes Structure NQF PP PC patients NCP 1.5 Members of the specialist palliative care team are appropriately trained, credentialed and/or certified in their area of expertise Add     
Gen Structures / Processes Structure NCP PC service NCP 1.6 The palliative care program has policies/procedures that specify conduct of regular and systematic measurement, analysis, review, evaluation, goal setting, and revision of the processes and outcomes of care. Add     
Gen Structures / Processes Structure NQF PP PC patients NCP 1.7 The palliative care program has a formal team wellness or self-care program Add     
Gen Structures / Processes Structure NCP PC patients NCP 1.8 Non-hospice palliative care programs have a relationship with one or more hospices and other community resources to ensure continuity of the highest-quality palliative care across the care continuum Add     
Gen Structures / Processes Process ACOVE Vulnerable elders NCP 1.1 IF a vulnerable elder dies an expected death with metastatic cancer, oxygen-dependent pulmonary disease, NYHA Class III to IV congestive heart failure (CHF), end-stage liver disease, end-stage (Stage IV) renal disease, or dementia, THEN the chart should document pain and other symptoms, spiritual and existential concerns, caregiver burdens and needs for practical assistance, and advance care planning (ACP) within 6 months before death Add     
Gen Structures / Processes Process NQF PP PC patients NCP 1.1 Proportion of patients where the patient/surrogate preferences for goals of care, treatment options and setting of care are documented at the first assessment Add     
Gen Structures / Processes Process CAPC PC patients NCP 1.2 Goals of care/goals of treatment documented Add     
Gen Structures / Processes Process Japan Ca EOL Cancer patients NCP 1.2 Explanation of medical condition to patient or family Add     
Gen Structures / Processes Process Japan Ca EOL Cancer patients NCP 1.2 Explanation to family about course of disease until death Add     
Gen Structures / Processes Process Japan Ca EOL Cancer patients NCP 1.3 Documentation of discussion of strategy of care among physicians and nurses Add     
Gen Structures / Processes Process NCP PC service NCP 1.6 A quality assessment and performance improvement (QAPI) review is conducted across all the domains, including organizational structure, education, team utilization, and assessment. This review includes effectiveness of physical, psychological, psychiatric, social, spiritual, cultural, and ethical assessment and interventions to manage these aspects of care. Add     
Physical Structure PEACE PC patients NCP 2.1 Policy or procedure specifying frequency with which pain & dyspnea should be assessed Add     
Physical Process ACOVE Vulnerable elders NCP 2.1 IF a vulnerable elder is in hospice or has a preference for no hospitalization and is living with oxygen-dependent pulmonary disease, lung cancer, or NYHA Class II to IV CHF, THEN the medical record should document a plan for management of worsening or emergent dyspnea Add     
Physical Process ACOVE Vulnerable elders NCP 2.1 IF a vulnerable elder with end-stage metastatic cancer has obstructive gastrointestinal symptoms, THEN the medical record should document a plan for management of worsening or emergent nausea and vomiting Add     
Physical Process ACOVE Vulnerable elders NCP 2.1 IF a vulnerable elder with end-stage metastatic cancer is treated with opiates for pain, THEN the medical record should document a plan for management of worsening or emergent pain Add     
Physical Process ACOVE Vulnerable elders NCP 2.1 IF a vulnerable elder with metastatic cancer or oxygen-dependent pulmonary disease has dyspnea refractory to non-opiate medications, THEN opiate medications should be offered Add     
Physical Process ACOVE Vulnerable elders NCP 2.1 IF a vulnerable elder is diagnosed with lung cancer or cancer metastatic to lung, NYHA Class III to IV CHF, or oxygen-dependent pulmonary disease, THEN a self-reported assessment of dyspnea should be documented in the outpatient chart Add     
Physical Process AMA-PCPI NCQA Patients with advanced chronic or serious life threatening illnesses NCP 2.1 Percentage of patients with advanced chronic or serious life threatening illnesses that are screened for dyspnea. For those that are diagnosed with moderate or severe dyspnea, a documented plan of care to manage dyspnea exists. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients with cancer pain started on chronic opioid treatment who were offered either a prescription or nonprescription bowel regimen within 24 hours or had documented contraindication to a bowel regimen. Add     
Physical Process CAPC PC patients NCP 2.1 Symptom management plan documented for all moderate to severe symptoms Add     
Physical Process CAPC PC patients NCP 2.1 Symptom assessment documented on initial encounters Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Physician’s prescription order for dyspnea Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Documentation of physician’s prescription order for pain management Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Documentation of presence or absence of dyspnea Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Observation and care of mouth Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Documentation of presence of absence of pain Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Documentation of the degree of pain Add     
Physical Process PEACE PC patients NCP 2.1 % patients on opioids for whom a bowel regimen is ordered Add     
Physical Process PEACE PC patients NCP 2.1 % patients who were screened for dyspnea during the admission visit Add     
Physical Process PEACE PC patients NCP 2.1 % of patients with cognitive and language problems receiving pain assessment appropriate to their communication needs Add     
Psychological / Psychiatric Structure NCP PC patients NCP 3.1 The IDT includes professionals with skills and training in the potential psychological and psychiatric impact of serious or life threatening illness, on both the patient and family including depression, anxiety, delirium, and cognitive impairment Add     
Psychological / Psychiatric Structure PEACE PC patients NCP 3.1 Policy or procedure mandating use of standard questions to assess patient depression Add     
Psychological / Psychiatric Structure CAPC PC patients NCP 3.2 Presence of a bereavement policy/procedure that describes bereavement services provided to families of patients impacted by the palliative care program Add     
Psychological / Psychiatric Structure NCP PC patients NCP 3.2 The IDT includes professionals with appropriate education and skill in the care of patients, families and staff experiencing loss, grief, and bereavement Add     
Psychological / Psychiatric Process ACOVE Vulnerable elders NCP 3.1 IF a vulnerable elder’s spouse or significant other dies, THEN the vulnerable elder should be assessed for depression or thoughts of suicidality within 6 months Add     
Psychological / Psychiatric Process ASCO/QOPI Cancer patients NCP 3.1 Patient emotional well-being assessed by second office visit Add     
Psychological / Psychiatric Process ASCO/QOPI Cancer patients NCP 3.1 Action taken to address problems with emotional well-being by the second office visit Add     
Psychological / Psychiatric Process ASSIST Cancer patients NCP 3.1 % patients diagnosed with depression for whom a treatment plan for depression was documented. Add     
Psychological / Psychiatric Process ASSIST Cancer patients NCP 3.1 % patients treated for depression for whom a response to therapy was documented within 6 weeks. Add     
Psychological / Psychiatric Process Japan Ca EOL Cancer patients NCP 3.1 Documentation of degree and content of patient’s anxiety Add     
Psychological / Psychiatric Process Japan Ca EOL Cancer patients NCP 3.1 Documentation of emotional reaction to explanation of medical condition Add     
Psychological / Psychiatric Process Japan Ca EOL Cancer patients NCP 3.1 Documentation of presence of absence of delirium or agitation Add     
Psychological / Psychiatric Process PEACE PC patients NCP 3.1 For patients who screen positive for anxiety, % who receive treatment within 2 weeks of diagnosis Add     
Psychological / Psychiatric Process PEACE PC patients NCP 3.1 For patients diagnosed with depression, % who receive interpersonal or medication treatment within 2 weeks of diagnosis Add     
Psychological / Psychiatric Process PEACE PC patients NCP 3.1 For patients who screen positive for depression, % who receive further assessment, counseling or medication treatment Add     
Social Structure NCP PC patients NCP 4.1 The IDT includes a social worker with patient population specific skills in assessment and interventions in order to address social needs during a life-threatening or serious illness. Add     
Social Structure NQF PP PC patients NCP 4.2 Presence of policies and procedures that require development of a comprehensive social care plan which addresses the social, practical and legal needs of the patient and caregivers, including: relationships, communication, existing social and cultural networks, decision-making, work and school settings, finances, sexuality/intimacy, caregiver availability/stress, and access to medicines and equipment. Add     
Social Process ACOVE Vulnerable elders NCP 4.2 IF a vulnerable elder is a caregiver for a spouse, significant other, or dependent who is terminally ill or has very limited function, THEN the vulnerable elder should be assessed for caregiver financial, physical, and emotional stress Add     
Social Process Japan Ca EOL Cancer patients NCP 4.2 Documentation of configuration of family relationships Add     
Social Process Japan Ca EOL Cancer patients NCP 4.2 Documentation of coordination of social resources when patient had no family or friends Add     
Social Process NQF PP PC patients NCP 4.2 Proportion of patients/families who participated in a care conference with the interdisciplinary team Add     
Social Process NQF PP PC patients NCP 4.2 Proportion of patients/families who were invited to participate in a care conference with the interdisciplinary team Add     
Social Process NQF PP PC patients NCP 4.2 Proportion of patients for whom a comprehensive social care plan is developed (comprehensive social care plan addressed relationships, communication, existing social and cultural networks, decision-making, work and school settings, finances, sexuality/intimacy, caregiver availability/stress and access to medicines and equipment.) Add     
Spiritual Structure NQF PP PC patients NCP 5.1 Specialized palliative and hospice care teams should include spiritual care professionals appropriately trained and certified in palliative care. Add     
Spiritual Structure NQF PP PC patients NCP 5.2 Presence of a policy or procedure requiring assessment of religious, spiritual and existential concerns using a structured instrument Add     
Spiritual Structure NCP PC patients NCP 5.3 Palliative care programs create procedures to facilitate patients' access to clergy, religious, spiritual and culturally-based leaders, and/or healers in their own religious, spiritual, or cultural traditions. Add     
Spiritual Structure NCP PC patients NCP 5.3 Non-chaplain palliative care providers obtain training in basic spiritual screening and spiritual care skills Add     
Spiritual Structure NQF PP PC patients NCP 5.3 Spiritual care is available through organizational spiritual counseling or through the patient’s own clergy relationships Add     
Spiritual Structure NQF PP PC patients NCP 5.3 The organization/program has established partnerships with community clergy Add     
Spiritual Process Japan Ca EOL Cancer patients NCP 5.2 Documentation of patient’s religion Add     
Spiritual Process NQF PP PC patients NCP 5.2 Spiritual, religious, and existential dimensions of care are assessed Add     
Spiritual Process PEACE PC patients NCP 5.2 % patients with chart documentation of a discussion of spiritual or religious concerns Add     
Cultural Structure NCP PC patients NCP 6.1 Palliative care staff members identify community resources that serve various cultural groups Add     
Cultural Structure NQF PP PC patients NCP 6.1 Materials describing hospice and palliative care are available in the patient’s and family’s preferred language Add     
Cultural Structure PEACE PC patients NCP 6.1 Provision (availability) of interpreters or translators for non-English speaking or deaf patients Add     
Cultural Process Japan Ca EOL Cancer patients NCP 6.1 Family’s preference of explanation of medical condition Add     
EOL Care Process Japan Ca EOL Cancer patients NCP 7.1 Explanation to family 1 week prior to patient’s death Add     
EOL Care Process Japan Ca EOL Cancer patients NCP 7.1 Explanation to family of patient’s impending death Add     
EOL Care Process ACOVE Vulnerable elders NCP 7.2 IF a vulnerable elder who had dyspnea in the last 7 days of life died an expected death, THEN the chart should document dyspnea care and follow-up Add     
EOL Care Process ACOVE Vulnerable elders NCP 7.2 IF a vulnerable elder who was conscious during the last 7 days of life died an expected death, THEN the medical record should contain documentation about presence or absence of pain during the last 7 days of life Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Dyspnea addressed appropriately (dyspnea both assessed and addressed on either of the last two visits before death) Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Dyspnea assessed on either of the last two visits before death Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Dyspnea addressed on either of the last two visits before death Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Pain assessed on either of the last two visits before death Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Pain intensity quantified on either of the last two visits before death Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Plan of care for moderate/severe pain documented on either of the last two visits before death Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Pain addressed appropriately (pain assessed, intensity quantified and plan of care for moderate/severe pain documented on either of the last two visits before death) Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Hospice enrollment Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Hospice enrollment and enrolled more than 3 days before death Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Hospice enrollment and enrolled more than 7 days before death Add     
EOL Care Process Canada Ca EOL Cancer patients NCP 7.2 Enrollment in hospice or first referral to palliative care within 3 days of death Add     
EOL Care Process NQF PP PC patients NCP 7.2 Proportion of cases where the patient and family wishes about the care setting for site of death was documented Add     
EOL Care Process NQF PP PC patients NCP 7.4 Proportion of families for whom a bereavement care plan was implemented after the patient’s death Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 IF a vulnerable elder dies an expected death with metastatic cancer, oxygen-dependent pulmonary disease, NYHA Class III to IV CHF, end-stage liver disease, end-stage (Stage IV) renal disease, or dementia, THEN the chart should document discussion of the medical condition and goals for treatment with a designated surrogate, the patient’s preference for not involving a designated surrogate in discussions, or a note that a surrogate decision maker is unavailable within 6 months before death Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 ALL vulnerable elders should have in the outpatient chart patient’s surrogate decision maker, or documentation of a discussion to identify or search for a surrogate decision maker Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of goals of care/goals of treatment to the receiving service or facility Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of preferred method of communicating with the patient/family to the receiving service or facility Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of name and contact information for the surrogate decision maker to the receiving service or facility Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of name and contact information for the following physician to the receiving service or facility Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of the symptom management plan (including up to date medication information) to the receiving service or facility Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of caregiver needs to the receiving service or facility Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of follow-up appointments to the receiving service or facility Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of community services engaged to the receiving service or facility Add     
Ethical/Legal Process Joint Commission Individuals with heart failure NCP 8.1 Percentage of heart failure patients who have documentation in the medical record of a one-time discussion of advance directives/advance care planning with a healthcare provider. Add     
Ethical/Legal Process Joint Commission Individuals with heart failure NCP 8.1 % heart failure patients who have documentation in the medical record that an advance directive was executed. Add     
Ethical/Legal Process NCQA Individuals aged ≥65 years NCP 8.1 % patients aged ≥65 years who have an advance care plan or surrogate decision maker documented in the medical record or documentation that an ACP was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan Add     
Ethical/Legal Process NQF PP PC patients NCP 8.1 Proportion of minors with decision-making capacity where the child’s views and preferences for medical care are documented Add     
Ethical/Legal Process PEACE PC patients NCP 8.1 % patients with chart documentation of an advanced directive or discussion that there is no advanced directive Add     
Ethical/Legal Process PEACE PC patients NCP 8.1 % patients with impaired decision-making (dementia, coma or other altered mental status) with documentation of name and contact information for their surrogate Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients are satisfied with the counseling aspects of ‘‘politeness’’ and ‘‘being taken seriously’’ Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients experience respect for their autonomy Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients experience respect for their privacy Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients experience expertise and continuity Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients get support for their physical symptoms (pain, fatigue, dyspnea, constipation) Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients in the last month before their death were in the location of their preference Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients indicate that caregivers respect their life stance Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients indicate that they feel that life is worthwhile Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients indicate that they receive contradictory information Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients indicate that they receive understandable explanations Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients know who the contact person is for their care Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients receive attention from their caregivers Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients receive help with physical care Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients receive information about the advantages and disadvantages of various types of treatments Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients receive information about the expected course of the illness Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients receive support when they feel anxious or feel depressed Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients indicate that they had access to a counselor for spiritual problems Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Percentage of patients who receive medical aids soon enough Add     
Clinical/Pt-reported Outcome PEACE PC patients NCP 2.1 % patients who had moderate or severe pain on a standard rating scale at any time in the last week of life Add     
Social Outcome Common use PC service NA % referring providers reporting they would use the PC service again Add     
Social Outcome Netherlands PC PC patients NA Extent to which direct relatives considered that the patient had the opportunity to be alone Add     
Social Outcome Netherlands PC PC patients NA Extent to which relatives indicate that the patient had access to a counselor for spiritual problems Add     
Social Outcome Netherlands PC PC patients NA Extent to which relatives indicate that the patient received support with preparations for saying goodbye Add     
Social Outcome Netherlands PC PC patients NA Extent to which relatives indicate that the patient was asked about her/his opinions with regard to end-of-life decisions Add     
Social Outcome Netherlands PC PC patients NA Extent to which relatives indicate that there was attention and respect for the psychosocial and spiritual well-being of the patient Add     
Social Outcome Netherlands PC PC patients NA Percentage of relatives who indicate that the patient died peacefully Add     
Social Outcome Netherlands PC PC patients NA Percentage of relatives who indicate that the patient had accepted her/his approaching death Add     
Social Outcome PEACE PC patients NA % families reporting the hospice (or PC providers) attended to family needs for information about medication, treatment and symptoms Add     
Social Outcome PEACE PC patients NA % families who respond "Always" to survey question of how often family was kept informed about patient's condition Add     
Social Outcome PEACE PC patients NA % families reporting they were informed of what to expect around the time of death Add     
Utilization/Fiscal Outcome Canada Ca EOL Cancer patients NA # individuals who died who were seen by specialty palliative care Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NA Cost of care or health care expenditures for hospital care last month of life Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NA Cost of care or health care expenditures last 6 months of life Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NA Patients with referred to PC >3 months prior to death Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NA Patients with multiple contacts with a PC program Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with chronic illness NA Hospice days per decedent in the last 6 months of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with chronic illness NA % decedents enrolled in hospice in the last 6 months of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with cancer NA % cancer patients enrolled in hospice in the last month of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with cancer NA Hospice days per cancer patient during the last moth of life Add     
Utilization/Fiscal Outcome Canada Ca EOL Cancer patients NCP 1.6 Interval between date last chemotherapy administered and death Add     
Utilization/Fiscal Outcome Canada Ca EOL Cancer patients NCP 1.6 Number of patients with >1 emergency room visit in the last 30 days of life Add     
Utilization/Fiscal Outcome Canada Ca EOL Cancer patients NCP 1.6 Number of patients with >1 hospital admission in the final 30 days of life Add     
Utilization/Fiscal Outcome Canada Ca EOL Cancer patients NCP 1.6 # emergency room visits in the last 30 days of life Add     
Utilization/Fiscal Outcome Canada Ca EOL Cancer patients NCP 1.6 # patients with >14 hospital days in the final 30 days of life Add     
Utilization/Fiscal Outcome CMS Individuals with AMI, CHF, or Pneumonia NCP 1.6 Number 30-day mortalities (death within 30 days of hospital admission) Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NCP 1.6 ICU admissions in the last month of life Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NCP 1.6 ICU admissions in the last six months of life Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NCP 1.6 Acute care days in the last month of life Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NCP 1.6 ICU days in the last six months of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents NCP 1.6 % decedents hospitalized in the last 6 months of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents NCP 1.6 % deaths occurring in the acute care hospital Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents NCP 1.6 % Decedents Admitted to ICU/CCU During the Hospitalization in Which Death Occurred Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with cancer NCP 1.6 % cancer patients hospitalized in the last month of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with cancer NCP 1.6 % cancer patients admitted to ICU during the last month of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with cancer NCP 1.6 % cancer patients receiving life sustaining procedure during the last month of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with cancer NCP 1.6 % cancer patients dying in the hospital Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents NCP 1.6 Inpatient Days per Decedent During the Last Six Months of Life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents NCP 1.6 Inpatient Days per Decedent During the Hospitalization In Which Death Occurred Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with cancer NCP 1.6 % receiving chemotherapy in the last two weeks of life Add     
Operational Structure Common use PC service NA Care settings/models offered (inpatient consult, inpatient unit, home-based, nursing home, clinic, telephone/distance, etc.) Add     
Operational Process CAPC PC service NA Patient demographics (age, sex, race/ethnicity) Add     
Operational Process CAPC PC service NA Disease distribution (cancer/non-cancer, at minimum) Add     
Operational Process CAPC PC service NA Age distribution (0-1, 2-18, 18-65, >65) Add     
Operational Process CAPC PC service NA # referrals by clinical service (medicine, cardiology, etc.) and / or physician Add     
Operational Process Common use PC service NA Average program cost per patient (per admission, day or month) Add     
Operational Process Common use Provider organization NA Distribution of primary language spoken by patients and families Add     
Operational Process Common use Provider organization NA Payer distribution (# and % of all served with Medicare, Medicaid, commercial HMO, etc.) Add     
Operational Process Common use PC service NA Number of new patients served / year Add     
Operational Process Common use PC service NA Average interval between referral and first contact with PC service Add     
Operational Process Common use PC service NA Number of days or months patients are followed (average, median and range) Add     
Operational Process Common use PC service NA Average number of contacts per patient, per setting Add     
Operational Process Common use PC service NA Reasons for discharge (death, discharge to hospice, patient initiated disenrollment, no longer qualifies for services, etc.) Add     
Operational Process Common use PC service NA Proportion of individuals who are offered care from a PC service who accept Add     

FILTERS

Step 1: Required Data: Select the types of data that are or could be available for tracking metrics
Step 2: Metric Focus and Type: Use these variables to specify the focus and types of metrics that you want to consider
Metric Focus
Metric Type
Step 3: Endorsements and Sources: Use these items to limit your search to metrics that have National Quality Forum endorsement, are Measuring What Matters recommended, or those from specific sources.
NQF Endorsement
MWM Recommended
Metric Source

124 METRICS FOUND

Metrics that meet the criteria specified in the Filters section.

Domain Metric Type Source Original Population NCP Ref Metric or Quality Indicator Add
Gen Structures / Processes Structure NQF PP PC patients NCP 1.3 In rural areas where accessing specialized care is difficult, organizations should institute telehealth and telemedicine communications Add     
Gen Structures / Processes Process Common use Provider organization NA Proportion of staff nurses receiving education/training in palliative care concepts Add     
Gen Structures / Processes Process Common use Provider organization NA Proportion of case managers and discharge planners receiving education/training in palliative care concepts Add     
Gen Structures / Processes Process Common use Provider organization NA Proportion of staff social workers receiving education/training in palliative care concepts Add     
Gen Structures / Processes Process ACOVE Vulnerable elders NCP 1.1 IF a vulnerable elder dies an expected death with metastatic cancer, oxygen-dependent pulmonary disease, NYHA Class III to IV congestive heart failure (CHF), end-stage liver disease, end-stage (Stage IV) renal disease, or dementia, THEN the chart should document pain and other symptoms, spiritual and existential concerns, caregiver burdens and needs for practical assistance, and advance care planning (ACP) within 6 months before death Add     
Gen Structures / Processes Process ASSIST Cancer patients NCP 1.2 % patients who underwent chemotherapy and, prior to chemotherapy, were informed about the risks and benefits of treatment, including likely symptoms and side effects, and whether the treatment intent is curative or palliative. Add     
Gen Structures / Processes Process Japan Ca EOL Cancer patients NCP 1.2 Explanation of medical condition to patient or family Add     
Gen Structures / Processes Process Japan Ca EOL Cancer patients NCP 1.2 Explanation to family about course of disease until death Add     
Gen Structures / Processes Process ASSIST Cancer patients NCP 2.2 % patients treated with enteral or parenteral nutrition who had an assessment prior to starting nutrition that there was difficulty maintaining nutrition due to significant gastrointestinal issues and that expected life expectancy was at least one month. Add     
Physical Process ACOVE Vulnerable elders NCP 2.1 IF a vulnerable elder is in hospice or has a preference for no hospitalization and is living with oxygen-dependent pulmonary disease, lung cancer, or NYHA Class II to IV CHF, THEN the medical record should document a plan for management of worsening or emergent dyspnea Add     
Physical Process ACOVE Vulnerable elders NCP 2.1 IF a vulnerable elder with end-stage metastatic cancer has obstructive gastrointestinal symptoms, THEN the medical record should document a plan for management of worsening or emergent nausea and vomiting Add     
Physical Process ACOVE Vulnerable elders NCP 2.1 IF a vulnerable elder with end-stage metastatic cancer is treated with opiates for pain, THEN the medical record should document a plan for management of worsening or emergent pain Add     
Physical Process ACOVE Vulnerable elders NCP 2.1 IF a vulnerable elder with metastatic cancer or oxygen-dependent pulmonary disease has dyspnea refractory to non-opiate medications, THEN opiate medications should be offered Add     
Physical Process ACOVE Vulnerable elders NCP 2.1 IF a vulnerable elder is diagnosed with lung cancer or cancer metastatic to lung, NYHA Class III to IV CHF, or oxygen-dependent pulmonary disease, THEN a self-reported assessment of dyspnea should be documented in the outpatient chart Add     
Physical Process AMA-PCPI NCQA Patients with advanced chronic or serious life threatening illnesses NCP 2.1 Percentage of patients with advanced chronic or serious life threatening illnesses that are screened for dyspnea. For those that are diagnosed with moderate or severe dyspnea, a documented plan of care to manage dyspnea exists. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients found to have severe, symptomatic anemia (hemoglobin less than 8 g/dl) for whom transfusion with packed red cells was offered within 24 hours. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients with cancer pain started on chronic opioid treatment who were offered either a prescription or nonprescription bowel regimen within 24 hours or had documented contraindication to a bowel regimen. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients undergoing chemotherapy with a high-risk (greater than 10%) of chemotherapy-induced diarrhea for whom an antidiarrheal agent was prescribed on or before treatment was initiated. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % outpatients with primary lung cancer or advanced cancer who reported new or worsening dyspnea who were offered symptomatic management or treatment directed at an underlying cause within one month. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients with dyspnea and a malignant pleural effusion who were offered thoracentesis within one month of the initial diagnosis of the effusion, or other treatment (e.g., diuresis) that resulted in a reduction in the effusion or symptomatic dyspnea. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients undergoing chemotherapy treatment with a high acute emetic risk for whom a 3-drug regimen including single doses of a 5-HT3 receptor antagonist, dexamethasone, and selective neurokinin-1 receptor blocker was given immediately prior to chemotherapy. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients undergoing chemotherapy treatment with a moderate acute emetic risk for whom a 2-drug regimen including a 5-HT3 receptor antagonist and dexamethasone were given immediately prior to chemotherapy. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients with new neurologic symptoms or findings on physical examination consistent with spinal cord compression who were treated with steroids as soon as possible, but within 24 hours or had a contraindication to steroids documented. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients with cancer pain started on a long-acting opioid formulation for whom a short-acting opioid formulation for breakthrough pain was also provided. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients with advanced cancer who received radiation treatment for painful bone metastases for whom single-fraction radiation was offered OR there was documentation of a contraindication to single-fraction treatment. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients with confirmation of spinal cord compression on radiologic examination for whom radiotherapy or surgical decompression was initiated within 24 hours or had a contraindication for such therapy documented. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients treated with an appetite stimulant for anorexia who had an assessment before or on the next visit to the same outpatient site of whether or not there was an improvement in anorexia. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients with a malignant pleural effusion who underwent thoracentesis for whom there was a repeat assessment of dyspnea within one week. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % outpatients not receiving chemotherapy or radiation who were treated for nausea or vomiting with an antiemetic medication for whom the effectiveness of treatment was evaluated before or on the next visit to the same outpatient site. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients treated for spinal cord compression for whom there was follow-up of neurologic symptoms and signs within 1 week after treatment was completed. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients whose outpatient cancer pain regimen changed for whom there was an assessment of the effectiveness of the treatment at or before the next outpatient visit with that provider or at another cancer-related outpatient visit. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients found to have anemia with a hemoglobin less than 10 g/dl for whom the presence and severity of anemia-related symptoms (e.g., fatigue, dyspnea, and lightheadedness) were evaluated. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients who presented for an initial visit for cancer affecting the oropharynx or gastrointestinal tract or advanced cancer at a cancer-related outpatient site for whom there was an assessment for the presence or absence of anorexia or dysphagia. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients undergoing chemotherapy who have diarrhea for whom all of the following were assessed: history of onset and duration, number of stools and stool composition, and at least one of the associated symptoms (fever, dizziness, abdominal pain/cramping, nausea/vomiting, decreased performance status, sepsis, fever, bleeding, or dehydration). Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients who reported new or worsening dyspnea for whom there was documentation of cause or of investigation of at least one of the following: hypoxia, anemia, bronchospasm or chronic obstructive pulmonary disease, pleural effusion, tumor obstruction of bronchi or the trachea, pneumonia, or pulmonary embolism. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % known cancer patients who are newly diagnosed with cancer who had an assessment of the presence or absence of fatigue. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients seen for an initial visit or any visit while undergoing chemotherapy at a cancer-related outpatient site for whom there was an assessment of the presence or absence of fatigue. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients undergoing moderately or highly emetic chemotherapy or with cancer affecting the gastrointestinal tract or abdomen seen for a visit in a cancer-related outpatient setting for whom the presence or absence of nausea or vomiting was assessed at every visit. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients with new neurologic symptoms or findings on a physical examination consistent with a spinal cord compression for whom a whole-spine magnetic resonance imaging (MRI) scan or myelography was performed as soon as possible, within 24 hours OR there was documentation of why an MRI scan was not appropriate. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients who had a cancer-related outpatient visit who were screened for the presence or absence and intensity of pain using a numeric pain score. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients treated with agents that block epidermal growth factor receptors (EGFRs) for whom the presence and severity of skin rash was evaluated within one month after starting the treatments and at each visit. Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Physician’s prescription order for dyspnea Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Documentation of physician’s prescription order for pain management Add     
Physical Process PEACE PC patients NCP 2.1 % patients on opioids for whom a bowel regimen is ordered Add     
Psychological / Psychiatric Process ACOVE Vulnerable elders NCP 3.1 IF a vulnerable elder’s spouse or significant other dies, THEN the vulnerable elder should be assessed for depression or thoughts of suicidality within 6 months Add     
Psychological / Psychiatric Process ASCO/QOPI Cancer patients NCP 3.1 Patient emotional well-being assessed by second office visit Add     
Psychological / Psychiatric Process ASCO/QOPI Cancer patients NCP 3.1 Action taken to address problems with emotional well-being by the second office visit Add     
Psychological / Psychiatric Process ASSIST Cancer patients NCP 3.1 % patients diagnosed with depression for whom a treatment plan for depression was documented. Add     
Psychological / Psychiatric Process ASSIST Cancer patients NCP 3.1 % patients treated for depression for whom a response to therapy was documented within 6 weeks. Add     
Psychological / Psychiatric Process Japan Ca EOL Cancer patients NCP 3.1 Documentation of degree and content of patient’s anxiety Add     
Psychological / Psychiatric Process Japan Ca EOL Cancer patients NCP 3.1 Documentation of emotional reaction to explanation of medical condition Add     
Psychological / Psychiatric Process Japan Ca EOL Cancer patients NCP 3.1 Documentation of presence of absence of delirium or agitation Add     
Psychological / Psychiatric Process PEACE PC patients NCP 3.1 For patients who screen positive for anxiety, % who receive treatment within 2 weeks of diagnosis Add     
Psychological / Psychiatric Process PEACE PC patients NCP 3.1 For patients diagnosed with depression, % who receive interpersonal or medication treatment within 2 weeks of diagnosis Add     
Psychological / Psychiatric Process PEACE PC patients NCP 3.1 For patients who screen positive for depression, % who receive further assessment, counseling or medication treatment Add     
Social Process ACOVE Vulnerable elders NCP 4.2 IF a vulnerable elder is a caregiver for a spouse, significant other, or dependent who is terminally ill or has very limited function, THEN the vulnerable elder should be assessed for caregiver financial, physical, and emotional stress Add     
Social Process Japan Ca EOL Cancer patients NCP 4.2 Documentation of configuration of family relationships Add     
Social Process Japan Ca EOL Cancer patients NCP 4.2 Documentation of coordination of social resources when patient had no family or friends Add     
Spiritual Process Japan Ca EOL Cancer patients NCP 5.2 Documentation of patient’s religion Add     
Cultural Structure NQF PP PC patients NCP 6.1 Materials describing hospice and palliative care are available in the patient’s and family’s preferred language Add     
Cultural Process Japan Ca EOL Cancer patients NCP 6.1 Family’s preference of explanation of medical condition Add     
EOL Care Structure NQF PP PC patients NCP 7.4 Presence of policies/ procedures that require developing a comprehensive grief and bereavement plan for families of patients who died Add     
EOL Care Process Japan Ca EOL Cancer patients NCP 7.1 Explanation to family 1 week prior to patient’s death Add     
EOL Care Process Japan Ca EOL Cancer patients NCP 7.1 Explanation to family of patient’s impending death Add     
EOL Care Process ACOVE Vulnerable elders NCP 7.2 IF a vulnerable elder who had dyspnea in the last 7 days of life died an expected death, THEN the chart should document dyspnea care and follow-up Add     
EOL Care Process ACOVE Vulnerable elders NCP 7.2 IF a vulnerable elder who was conscious during the last 7 days of life died an expected death, THEN the medical record should contain documentation about presence or absence of pain during the last 7 days of life Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Dyspnea addressed appropriately (dyspnea both assessed and addressed on either of the last two visits before death) Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Dyspnea assessed on either of the last two visits before death Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Dyspnea addressed on either of the last two visits before death Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Pain assessed on either of the last two visits before death Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Pain intensity quantified on either of the last two visits before death Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Plan of care for moderate/severe pain documented on either of the last two visits before death Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Pain addressed appropriately (pain assessed, intensity quantified and plan of care for moderate/severe pain documented on either of the last two visits before death) Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Hospice enrollment Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Hospice enrollment or palliative care referral Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Hospice enrollment and enrolled more than 3 days before death Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Hospice enrollment and enrolled more than 7 days before death Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 Hospice enrollment, palliative care referral, or documented discussion Add     
EOL Care Process ASCO/QOPI Cancer patients NCP 7.2 For patients not referred, hospice or palliative care discussed within the last 2 months of life Add     
EOL Care Process Canada Ca EOL Cancer patients NCP 7.2 Enrollment in hospice or first referral to palliative care within 3 days of death Add     
Ethical/legal Structure NQF PP PC patients NCP 8.1 Presence of policies, procedures and / or technology that promotes (appropriately secure) access to advance directives and surrogacy designations across settings Add     
Ethical/Legal Structure NQF PP PC patients NCP 8.2 Presence of processes to manage ethical aspects involving discordant patient, family, and caregiver goals and to handle disputes and uncertainties regarding a patient’s previously stated preferences and current family or proxy decisions Add     
Ethical/Legal Structure NQF PP PC patients NCP 8.2 Ethics consultation or an Ethics Committee is available to address ethical conflicts at the end of life Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 IF a vulnerable elder has documented treatment preferences to withhold or withdraw life-sustaining treatment (e.g., DNR order, no tube feeding, no hospital transfer) THEN these treatment preferences should be followed Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 IF a vulnerable elder with dementia has a gastrostomy or jejunum tube placed, THEN before placement, the medical record should document patient preferences concerning tube feeding; discussion of patient preferences or best interests if the patient is decisionally incapacitated and a surrogate decision maker is available; or use of a formal decision mechanism if the patient is decisionally incapacitated and a surrogate decision maker is not available Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 IF a vulnerable elder has an advance directive in the outpatient, inpatient, or nursing home medical record, or the patient reports the existence of an advance directive in an interview, and the patient receives care in a second venue, THEN the advance directive should be present in the medical record at the second venue, or documentation should acknowledge its existence and its contents Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 IF a vulnerable elder dies an expected death with metastatic cancer, oxygen-dependent pulmonary disease, NYHA Class III to IV CHF, end-stage liver disease, end-stage (Stage IV) renal disease, or dementia, THEN the chart should document discussion of the medical condition and goals for treatment with a designated surrogate, the patient’s preference for not involving a designated surrogate in discussions, or a note that a surrogate decision maker is unavailable within 6 months before death Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 IF a vulnerable elder with decision-making capacity has orders in the hospital or nursing home to withhold or withdraw a life-sustaining treatment (e.g., DNR order), THEN the medical record should document patient participation in the decision or why the patient did not participate Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 ALL vulnerable elders should have in the outpatient chart patient’s surrogate decision maker, or documentation of a discussion to identify or search for a surrogate decision maker Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 IF a vulnerable elder is admitted to the hospital or nursing home, THEN within 48 hours of admission, the medical record should contain the patient’s surrogate decision maker or documentation of a discussion to identify or search for surrogate decision maker Add     
Ethical/Legal Process ASSIST Cancer patients NCP 8.1 % patients with advanced cancer who died an expected death for whom there was documentation of an advanced directive or a surrogate decision maker in the medical record. Add     
Ethical/Legal Process Joint Commission Individuals with heart failure NCP 8.1 Percentage of heart failure patients who have documentation in the medical record of a one-time discussion of advance directives/advance care planning with a healthcare provider. Add     
Ethical/Legal Process Joint Commission Individuals with heart failure NCP 8.1 % heart failure patients who have documentation in the medical record that an advance directive was executed. Add     
Ethical/Legal Process NCQA Individuals aged ≥65 years NCP 8.1 % patients aged ≥65 years who have an advance care plan or surrogate decision maker documented in the medical record or documentation that an ACP was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan Add     
Utilization/Fiscal Outcome Canada Ca EOL Cancer patients NA # individuals who died who were seen by specialty palliative care Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NA Cost of care or health care expenditures for hospital care last month of life Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NA Cost of care or health care expenditures last 6 months of life Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NA Patients with referred to PC >3 months prior to death Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NA Patients with multiple contacts with a PC program Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with chronic illness NA Hospice days per decedent in the last 6 months of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with chronic illness NA % decedents enrolled in hospice in the last 6 months of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with cancer NA % cancer patients enrolled in hospice in the last month of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with cancer NA Hospice days per cancer patient during the last moth of life Add     
Utilization/Fiscal Outcome Canada Ca EOL Cancer patients NCP 1.6 Interval between date last chemotherapy administered and death Add     
Utilization/Fiscal Outcome Canada Ca EOL Cancer patients NCP 1.6 Number of patients with >1 emergency room visit in the last 30 days of life Add     
Utilization/Fiscal Outcome Canada Ca EOL Cancer patients NCP 1.6 Number of patients with >1 hospital admission in the final 30 days of life Add     
Utilization/Fiscal Outcome Canada Ca EOL Cancer patients NCP 1.6 # emergency room visits in the last 30 days of life Add     
Utilization/Fiscal Outcome Canada Ca EOL Cancer patients NCP 1.6 # patients with >14 hospital days in the final 30 days of life Add     
Utilization/Fiscal Outcome CMS Individuals with AMI, CHF, or Pneumonia NCP 1.6 Number 30-day mortalities (death within 30 days of hospital admission) Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NCP 1.6 ICU admissions in the last month of life Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NCP 1.6 ICU admissions in the last six months of life Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NCP 1.6 Acute care days in the last month of life Add     
Utilization/Fiscal Outcome Common use Patients with advanced chronic or serious life threatening illnesses NCP 1.6 ICU days in the last six months of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents NCP 1.6 % decedents hospitalized in the last 6 months of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents NCP 1.6 % deaths occurring in the acute care hospital Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents NCP 1.6 % Decedents Admitted to ICU/CCU During the Hospitalization in Which Death Occurred Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with cancer NCP 1.6 % cancer patients hospitalized in the last month of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with cancer NCP 1.6 % cancer patients admitted to ICU during the last month of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with cancer NCP 1.6 % cancer patients receiving life sustaining procedure during the last month of life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with cancer NCP 1.6 % cancer patients dying in the hospital Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents NCP 1.6 Inpatient Days per Decedent During the Last Six Months of Life Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents NCP 1.6 Inpatient Days per Decedent During the Hospitalization In Which Death Occurred Add     
Utilization/Fiscal Outcome Dartmouth Atlas Medicare decedents with cancer NCP 1.6 % receiving chemotherapy in the last two weeks of life Add     
Operational Structure Common use PC service NA Care settings/models offered (inpatient consult, inpatient unit, home-based, nursing home, clinic, telephone/distance, etc.) Add     

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168 METRICS FOUND

Metrics that meet the criteria specified in the Filters section.

Domain Metric Type Source Original Population NCP Ref Metric or Quality Indicator Add
Gen Structures / Processes Structure NQF PP PC patients NCP 1.2 Policies/procedures are in place that ensure that on transfer between healthcare settings, there is timely and thorough communication of the patient’s goals, preferences, values and clinical information Add     
Gen Structures / Processes Structure CAPC PC patients NCP 1.3 At minimum, Monday–Friday inpatient consultation availability and 24/7 telephone support Add     
Gen Structures / Processes Structure NQF PP PC patients NCP 1.3 Patients and families have access to palliative care expertise and staff 24 hours a day 7 days a week Add     
Gen Structures / Processes Structure NQF PP PC patients NCP 1.3 In rural areas where accessing specialized care is difficult, organizations should institute telehealth and telemedicine communications Add     
Gen Structures / Processes Structure NQF PP PC patients NCP 1.3 Palliative care is provided by an interdisciplinary team Add     
Gen Structures / Processes Structure NCP PC patients NCP 1.4 Presence of policies and procedures that outline the program's responsibilities to its volunteers Add     
Gen Structures / Processes Structure NCP PC patients NCP 1.4 An appropriately educated and experienced professional team member screens, educates, coordinates and supervises volunteers Add     
Gen Structures / Processes Structure NCP PC patients NCP 1.4 For programs utilizing volunteers, policies and procedures are in place to ensure safe, quality volunteer programs including: recruitment, screening (including background checks), training, job descriptions and role clarification, work practices, support, supervision, and performance evaluation Add     
Gen Structures / Processes Structure NQF PP PC patients NCP 1.5 Support for education and training is available to the interdisciplinary team. Add     
Gen Structures / Processes Structure NQF PP PC patients NCP 1.5 Members of the specialist palliative care team are appropriately trained, credentialed and/or certified in their area of expertise Add     
Gen Structures / Processes Structure NCP PC service NCP 1.6 The palliative care program has policies/procedures that specify conduct of regular and systematic measurement, analysis, review, evaluation, goal setting, and revision of the processes and outcomes of care. Add     
Gen Structures / Processes Structure NQF PP PC patients NCP 1.7 The palliative care program has a formal team wellness or self-care program Add     
Gen Structures / Processes Structure NCP PC patients NCP 1.8 Non-hospice palliative care programs have a relationship with one or more hospices and other community resources to ensure continuity of the highest-quality palliative care across the care continuum Add     
Gen Structures / Processes Process NQF PP PC patients NCP 1.1 Proportion of patients where the patient/surrogate preferences for goals of care, treatment options and setting of care are documented at the first assessment Add     
Gen Structures / Processes Process PEACE PC patients NCP 1.1 % seriously ill patients admitted to the hospital for >1 day who had a comprehensive assessment (screening for physical symptoms and discussion of the patient/family's emotional or psychological needs) completed within 24 hours of admission Add     
Gen Structures / Processes Process UHC PC Adults with high-mortality diagnoses NCP 1.1 % patients with documentation of prognosis, psychosocial symptoms, functional status and overall symptom distress within 48 hours of admission Add     
Gen Structures / Processes Process CAPC PC patients NCP 1.2 Goals of care/goals of treatment documented Add     
Gen Structures / Processes Process Japan Ca EOL Cancer patients NCP 1.2 Explanation of medical condition to patient or family Add     
Gen Structures / Processes Process Japan Ca EOL Cancer patients NCP 1.2 Explanation to family about course of disease until death Add     
Gen Structures / Processes Process UHC PC Adults with high-mortality diagnoses NCP 1.2 Documentation of a meeting between patient/family and members of the healthcare team to discuss the patient’s treatment preferences or the plans for discharge disposition, within 1 week of admission Add     
Gen Structures / Processes Process UHC PC Adults with high-mortality diagnoses NCP 1.2 Proportion of patients with discharge disposition plan documented within 4 days of admission Add     
Gen Structures / Processes Process UHC PC Adults with high-mortality diagnoses NCP 1.2 Proportion of patients with documentation that a discharge planner arranged for any needed home services Add     
Gen Structures / Processes Process Japan Ca EOL Cancer patients NCP 1.3 Documentation of discussion of strategy of care among physicians and nurses Add     
Gen Structures / Processes Process NCP PC service NCP 1.6 A quality assessment and performance improvement (QAPI) review is conducted across all the domains, including organizational structure, education, team utilization, and assessment. This review includes effectiveness of physical, psychological, psychiatric, social, spiritual, cultural, and ethical assessment and interventions to manage these aspects of care. Add     
Physical Structure PEACE PC patients NCP 2.1 Policy or procedure specifying frequency with which pain & dyspnea should be assessed Add     
Physical Process ASSIST Cancer patients NCP 2.1 % inpatients with primary lung cancer or advanced cancer with dyspnea on admission who were offered symptomatic management or treatment directed at an underlying cause within 24 hours. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % inpatients with nausea or vomiting who were offered a change in therapy within 24 hours of the initial report of nausea or vomiting. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients in the hospital treated for dyspnea who had an assessment within 24 hours that the treatment was effective in relieving dyspnea or that a change in treatment for dyspnea was made. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % hospitalized patients with cancer over the age of 65 or with advanced cancer with delirium for whom there was an assessment for the presence or absence of at least one of the following potential causes and their association with delirium: medication effects, central nervous system disease, infection, or metabolic processes. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients who report nausea or vomiting on admission to the hospital for whom potential underlying causes were assessed within 24 hours. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients with advanced cancer affecting the gastrointestinal tract or abdomen admitted to a hospital for whom the presence or absence of nausea or vomiting was assessed within 24 hours. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients admitted to the hospital who were screened for the presence or absence of pain. Add     
Physical Process CAPC PC patients NCP 2.1 Symptom management plan documented for all moderate to severe symptoms Add     
Physical Process CAPC PC consult service patients NCP 2.1 Reassessment of all symptoms documented no less than every three days Add     
Physical Process CAPC PC consult service patients NCP 2.1 At least daily reassessment documented for moderate to severe symptoms Add     
Physical Process CAPC PC patients NCP 2.1 Symptom assessment documented on initial encounters Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Physician’s prescription order for dyspnea Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Documentation of physician’s prescription order for pain management Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Documentation of presence or absence of dyspnea Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Observation and care of mouth Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Documentation of presence of absence of pain Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Documentation of the degree of pain Add     
Physical Process PEACE PC patients NCP 2.1 % patients on opioids for whom a bowel regimen is ordered Add     
Physical Process PEACE PC patients NCP 2.1 % patients on opioids who have a bowel regimen initiated within 1 day of opioid initiation Add     
Physical Process PEACE PC patients NCP 2.1 For patients who screened positive for constipation, % who receive treatment within 1 day of screening Add     
Physical Process PEACE PC patients NCP 2.1 For new ratings of shortness of breath ≥4 (on a ten-point scale) % with treatment (or indication of satisfaction with symptom) within 4 hours Add     
Physical Process PEACE PC patients NCP 2.1 For patients who screened positive for dyspnea, % who receive medication or non-medication treatment within 1 day of screening Add     
Physical Process PEACE PC patients NCP 2.1 For patients who screened positive for nausea, % who receive treatment within 1 day of screening Add     
Physical Process PEACE PC patients NCP 2.1 For patients who screened positive for moderate or severe pain on admission, % who had an order for pain medication within 1 day of screening Add     
Physical Process PEACE PC patients NCP 2.1 For seriously ill patients receiving specialty palliative care in an acute hospital setting >1 day who screened positive for moderate or severe pain on admission, % with medication or non-medication treatment within 24 hours of screening Add     
Physical Process PEACE PC patients NCP 2.1 For patients who screened positive for dyspnea, % who receive a 2nd assessment within 24 hours Add     
Physical Process PEACE PC patients NCP 2.1 % seriously ill patients receiving specialty palliative care in an acute hospital setting >1 day who have a screening for physical symptoms (pain, dyspnea, nausea, constipation) during the admission visit Add     
Physical Process PEACE PC patients NCP 2.1 % patients who were screened for dyspnea during the admission visit Add     
Physical Process PEACE PC patients NCP 2.1 % seriously ill hospitalized patients screened for pain during the palliative care initial encounter Add     
Physical Process PEACE PC patients NCP 2.1 For patients who screened positive for pain on admission, % with a clinical assessment within 1 day of screening Add     
Physical Process PEACE PC patients NCP 2.1 % of patients with cognitive and language problems receiving pain assessment appropriate to their communication needs Add     
Physical Process UHC PC Adults with high-mortality diagnoses NCP 2.1 Proportion of patients receiving opioids who had an order for a bowel regimen written within 24 hours of the order for the opioid Add     
Physical Process UHC PC Adults with high-mortality diagnoses NCP 2.1 Proportion of patients with dyspnea assessment within 48 hours of admission Add     
Physical Process UHC PC Adults with high-mortality diagnoses NCP 2.1 Documentation of pain assessment within 48 hours of admission Add     
Physical Process UHC PC Adults with high-mortality diagnoses NCP 2.1 Use of numeric pain scale Add     
Psychological / Psychiatric Structure NCP PC patients NCP 3.1 The IDT includes professionals with skills and training in the potential psychological and psychiatric impact of serious or life threatening illness, on both the patient and family including depression, anxiety, delirium, and cognitive impairment Add     
Psychological / Psychiatric Structure PEACE PC patients NCP 3.1 Policy or procedure mandating use of standard questions to assess patient depression Add     
Psychological / Psychiatric Structure CAPC PC patients NCP 3.2 Presence of a bereavement policy/procedure that describes bereavement services provided to families of patients impacted by the palliative care program Add     
Psychological / Psychiatric Structure NCP PC patients NCP 3.2 The IDT includes professionals with appropriate education and skill in the care of patients, families and staff experiencing loss, grief, and bereavement Add     
Psychological / Psychiatric Process Japan Ca EOL Cancer patients NCP 3.1 Documentation of degree and content of patient’s anxiety Add     
Psychological / Psychiatric Process Japan Ca EOL Cancer patients NCP 3.1 Documentation of emotional reaction to explanation of medical condition Add     
Psychological / Psychiatric Process Japan Ca EOL Cancer patients NCP 3.1 Documentation of presence of absence of delirium or agitation Add     
Psychological / Psychiatric Process PEACE PC patients NCP 3.1 % seriously ill patients receiving specialty palliative care in an acute hospital setting >1 day with chart documentation of a discussion of emotional or psychological needs Add     
Psychological / Psychiatric Process UHC PC Adults with high-mortality diagnoses NCP 3.1 Proportion of patients receiving a psychosocial assessment conducted by a psychologist, social worker, psychiatrist or other mental health expert completed within 4 days after admission (if an assessment had not been completed within the year prior to admission) Add     
Social Structure NCP PC patients NCP 4.1 The IDT includes a social worker with patient population specific skills in assessment and interventions in order to address social needs during a life-threatening or serious illness. Add     
Social Structure NQF PP PC patients NCP 4.2 Presence of policies and procedures that require development of a comprehensive social care plan which addresses the social, practical and legal needs of the patient and caregivers, including: relationships, communication, existing social and cultural networks, decision-making, work and school settings, finances, sexuality/intimacy, caregiver availability/stress, and access to medicines and equipment. Add     
Social Process Japan Ca EOL Cancer patients NCP 4.2 Documentation of configuration of family relationships Add     
Social Process Japan Ca EOL Cancer patients NCP 4.2 Documentation of coordination of social resources when patient had no family or friends Add     
Social Process NQF PP PC patients NCP 4.2 Proportion of patients/families who participated in a care conference with the interdisciplinary team Add     
Social Process NQF PP PC patients NCP 4.2 Proportion of patients/families who were invited to participate in a care conference with the interdisciplinary team Add     
Social Process NQF PP PC patients NCP 4.2 Proportion of patients for whom a comprehensive social care plan is developed (comprehensive social care plan addressed relationships, communication, existing social and cultural networks, decision-making, work and school settings, finances, sexuality/intimacy, caregiver availability/stress and access to medicines and equipment.) Add     
Spiritual Structure NQF PP PC patients NCP 5.1 Specialized palliative and hospice care teams should include spiritual care professionals appropriately trained and certified in palliative care. Add     
Spiritual Structure NQF PP PC patients NCP 5.2 Presence of a policy or procedure requiring assessment of religious, spiritual and existential concerns using a structured instrument Add     
Spiritual Structure NCP PC patients NCP 5.3 Palliative care programs create procedures to facilitate patients' access to clergy, religious, spiritual and culturally-based leaders, and/or healers in their own religious, spiritual, or cultural traditions. Add     
Spiritual Structure NCP PC patients NCP 5.3 Non-chaplain palliative care providers obtain training in basic spiritual screening and spiritual care skills Add     
Spiritual Structure NQF PP PC patients NCP 5.3 Spiritual care is available through organizational spiritual counseling or through the patient’s own clergy relationships Add     
Spiritual Structure NQF PP PC patients NCP 5.3 The organization/program has established partnerships with community clergy Add     
Spiritual Process Japan Ca EOL Cancer patients NCP 5.2 Documentation of patient’s religion Add     
Spiritual Process NQF PP PC patients NCP 5.2 Spiritual, religious, and existential dimensions of care are assessed Add     
Spiritual Process PEACE PC patients NCP 5.2 % patients with chart documentation of a discussion of spiritual or religious concerns Add     
Cultural Structure NCP PC patients NCP 6.1 Palliative care staff members identify community resources that serve various cultural groups Add     
Cultural Structure NQF PP PC patients NCP 6.1 Materials describing hospice and palliative care are available in the patient’s and family’s preferred language Add     
Cultural Structure PEACE PC patients NCP 6.1 Provision (availability) of interpreters or translators for non-English speaking or deaf patients Add     
Cultural Process Japan Ca EOL Cancer patients NCP 6.1 Family’s preference of explanation of medical condition Add     
EOL Care Structure NQF PP PC patients NCP 7.4 Presence of policies/ procedures that require developing a comprehensive grief and bereavement plan for families of patients who died Add     
EOL Care Process Japan Ca EOL Cancer patients NCP 7.1 Explanation to family 1 week prior to patient’s death Add     
EOL Care Process Japan Ca EOL Cancer patients NCP 7.1 Explanation to family of patient’s impending death Add     
EOL Care Process NQF PP PC patients NCP 7.1 Proportion of cases where the transition to the active dying phase was documented and communicated to the family Add     
EOL Care Process ACOVE Vulnerable elders NCP 7.2 IF a non-comatose vulnerable elder is not expected to survive, and a mechanical ventilator is withdrawn or withheld, THEN the chart should document whether the patient has dyspnea, and the patient should receive (or have orders available for) an opiate, benzodiazepine, or barbiturate infusion Add     
EOL Care Process ACOVE Vulnerable elders NCP 7.2 IF a vulnerable elder who had dyspnea in the last 7 days of life died an expected death, THEN the chart should document dyspnea care and follow-up Add     
EOL Care Process ACOVE Vulnerable elders NCP 7.2 IF a vulnerable elder who was conscious during the last 7 days of life died an expected death, THEN the medical record should contain documentation about presence or absence of pain during the last 7 days of life Add     
EOL Care Process Canada Ca EOL Cancer patients NCP 7.2 Enrollment in hospice or first referral to palliative care within 3 days of death Add     
EOL Care Process NQF PP PC patients NCP 7.2 Proportion of cases where the patient and family wishes about the care setting for site of death was documented Add     
EOL Care Process NQF PP PC patients NCP 7.4 Proportion of families for whom a bereavement care plan was implemented after the patient’s death Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of goals of care/goals of treatment to the receiving service or facility Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of preferred method of communicating with the patient/family to the receiving service or facility Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of name and contact information for the surrogate decision maker to the receiving service or facility Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of name and contact information for the following physician to the receiving service or facility Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of the symptom management plan (including up to date medication information) to the receiving service or facility Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of caregiver needs to the receiving service or facility Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of follow-up appointments to the receiving service or facility Add     
Ethical/Legal Process CAPC PC patients NCP 8.1 For patients transitioning across settings, the proportion with documentation of communication of community services engaged to the receiving service or facility Add     
Ethical/Legal Process NQF PP PC patients NCP 8.1 Proportion of minors with decision-making capacity where the child’s views and preferences for medical care are documented Add     
Ethical/Legal Process PEACE PC patients NCP 8.1 % patients with chart documentation of an advanced directive or discussion that there is no advanced directive Add     
Ethical/Legal Process PEACE PC patients NCP 8.1 % seriously ill patients receiving specialty palliative care in an acute hospital setting >1 day with chart documentation of preferences for life-sustaining treatments Add     
Ethical/Legal Process PEACE PC patients NCP 8.1 % patients with impaired decision-making (dementia, coma or other altered mental status) with documentation of name and contact information for their surrogate Add     
Ethical/Legal Process PEACE PC patients NCP 8.1 % seriously ill patients receiving specialty palliative care in an acute hospital setting >1 day with the name and contact information for surrogate decision maker in the chart or documentation that there is no surrogate. Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients are satisfied with the counseling aspects of ‘‘politeness’’ and ‘‘being taken seriously’’ Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients experience respect for their autonomy Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients experience respect for their privacy Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients experience expertise and continuity Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients get support for their physical symptoms (pain, fatigue, dyspnea, constipation) Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients in the last month before their death were in the location of their preference Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients indicate that caregivers respect their life stance Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients indicate that they feel that life is worthwhile Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients indicate that they receive contradictory information Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients indicate that they receive understandable explanations Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients know who the contact person is for their care Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients receive attention from their caregivers Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients receive help with physical care Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients receive information about the advantages and disadvantages of various types of treatments Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients receive information about the expected course of the illness Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients receive support when they feel anxious or feel depressed Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Extent to which patients indicate that they had access to a counselor for spiritual problems Add     
Clinical/Pt-reported Outcome Netherlands PC PC patients NA Percentage of patients who receive medical aids soon enough Add     
Clinical/Pt-reported Outcome PEACE PC patients NCP 2.1 For patients who screened positive for dyspnea, % who improved within 1 day of screening Add     
Clinical/Pt-reported Outcome PEACE PC patients NCP 2.1 For patients who screened positive for pain, % whose pain was at a comfortable level within 2 days of screening Add     
Clinical/Pt-reported Outcome PEACE PC patients NCP 2.1 For patients who screened positive for pain, % with improvement within 1 day of screening Add     
Clinical/Pt-reported Outcome PEACE PC patients NCP 2.1 % patients who had moderate or severe pain on a standard rating scale at any time in the last week of life Add     
Clinical/Pt-reported Outcome UHC PC Adults with high-mortality diagnoses NCP 2.1 Of patients reporting pain at admission, proportion where pain was relieved/reduced (to a score of 3 or less on a 0-10 scale) within 48 hours Add     
Clinical/Pt-reported Outcome UHC PC Adults with high-mortality diagnoses NCP 2.1 Of patients reporting dyspnea at admission, the proportion with dyspnea relieved or reduced (score of 3 or less on a 0-10 scale) within 48 hours of admission Add     
Social Outcome Common use PC service NA % referring providers reporting they would use the PC service again Add     
Social Outcome Netherlands PC PC patients NA Extent to which direct relatives considered that the patient had the opportunity to be alone Add     
Social Outcome Netherlands PC PC patients NA Extent to which relatives indicate that the patient had access to a counselor for spiritual problems Add     
Social Outcome Netherlands PC PC patients NA Extent to which relatives indicate that the patient received support with preparations for saying goodbye Add     
Social Outcome Netherlands PC PC patients NA Extent to which relatives indicate that the patient was asked about her/his opinions with regard to end-of-life decisions Add     
Social Outcome Netherlands PC PC patients NA Extent to which relatives indicate that there was attention and respect for the psychosocial and spiritual well-being of the patient Add     
Social Outcome Netherlands PC PC patients NA Percentage of relatives who indicate that the patient died peacefully Add     
Social Outcome Netherlands PC PC patients NA Percentage of relatives who indicate that the patient had accepted her/his approaching death Add     
Social Outcome PEACE PC patients NA % families reporting the hospice (or PC providers) attended to family needs for information about medication, treatment and symptoms Add     
Social Outcome PEACE PC patients NA % families who respond "Always" to survey question of how often family was kept informed about patient's condition Add     
Social Outcome PEACE PC patients NA % families reporting they were informed of what to expect around the time of death Add     
Utilization/Fiscal Outcome Canada Ca EOL Cancer patients NA # individuals who died who were seen by specialty palliative care Add     
Utilization/Fiscal Outcome Common use PC consult service patients NA Cost reduction/avoidance following inpatient PC consultation Add     
Operational Structure Common use PC service NA Care settings/models offered (inpatient consult, inpatient unit, home-based, nursing home, clinic, telephone/distance, etc.) Add     
Operational Process CAPC PC service NA Patient demographics (age, sex, race/ethnicity) Add     
Operational Process CAPC PC service NA Disease distribution (cancer/non-cancer, at minimum) Add     
Operational Process CAPC PC service NA Age distribution (0-1, 2-18, 18-65, >65) Add     
Operational Process CAPC PC service NA Distribution of discharge dispositions (death, hospice, home w/ home care, nursing facility, etc.) Add     
Operational Process CAPC PC service NA Palliative care consultation rate (consultations/100 admissions, or proportion all admissions with consultations) Add     
Operational Process CAPC PC service NA Location of consult origin (ward, critical care, ED) Add     
Operational Process CAPC PC service NA # referrals by clinical service (medicine, cardiology, etc.) and / or physician Add     
Operational Process CAPC PC service NA Consultation service volume (annual figures for number of unique individuals, number of distinct admissions, number of new and follow-up encounters) Add     
Operational Process CAPC PC service NA Interval between initial PC consultation and discharge Add     
Operational Process Common use PC service NA Average program cost per patient (per admission, day or month) Add     
Operational Process Common use Provider organization NA Distribution of primary language spoken by patients and families Add     
Operational Process Common use Provider organization NA Payer distribution (# and % of all served with Medicare, Medicaid, commercial HMO, etc.) Add     
Operational Process Common use PC service NA Number of new patients served / year Add     
Operational Process Common use PC service NA Average interval between referral and first contact with PC service Add     
Operational Process Common use PC service NA Number of days or months patients are followed (average, median and range) Add     
Operational Process Common use PC service NA Average number of contacts per patient, per setting Add     
Operational Process Common use PC service NA Reasons for discharge (death, discharge to hospice, patient initiated disenrollment, no longer qualifies for services, etc.) Add     
Operational Process Common use PC service NA Proportion of individuals who are offered care from a PC service who accept Add     

FILTERS

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Step 2: Metric Focus and Type: Use these variables to specify the focus and types of metrics that you want to consider
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Metric Type
Step 3: Endorsements and Sources: Use these items to limit your search to metrics that have National Quality Forum endorsement, are Measuring What Matters recommended, or those from specific sources.
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96 METRICS FOUND

Metrics that meet the criteria specified in the Filters section.

Domain Metric Type Source Original Population NCP Ref Metric or Quality Indicator Add
Gen Structures / Processes Structure NQF PP PC patients NCP 1.3 In rural areas where accessing specialized care is difficult, organizations should institute telehealth and telemedicine communications Add     
Gen Structures / Processes Structure RWJ CC Critical care unit patients NCP 1.6 Presence of a policy that allows for continuity of nursing care for patients with multiple-day stays in the ICU Add     
Gen Structures / Processes Structure RWJ CC Critical care unit patients NCP 1.7 Presence of a forum for ICU clinicians to review, discuss and debrief the experience of caring for dying patients and their families Add     
Gen Structures / Processes Structure RWJ CC Critical care unit patients NCP 1.9 Presence of a policy that allows for unrestricted visitation (in the ICU) by family members and friends (may include restrictions addressing number of visitors at one time, or preventing disturbance of other patients/family members or ICU functions, or asking individuals to wait in the waiting room during procedures.) Add     
Gen Structures / Processes Structure TICU PC Critical care unit patients NCP 1.9 Presence of dedicated space for meetings between clinicians and ICU families Add     
Gen Structures / Processes Process Common use Provider organization NA Proportion of staff nurses receiving education/training in palliative care concepts Add     
Gen Structures / Processes Process Common use Provider organization NA Proportion of case managers and discharge planners receiving education/training in palliative care concepts Add     
Gen Structures / Processes Process Common use Provider organization NA Proportion of staff social workers receiving education/training in palliative care concepts Add     
Gen Structures / Processes Process UHC PC Adults with high-mortality diagnoses NCP 1.1 % patients with documentation of prognosis, psychosocial symptoms, functional status and overall symptom distress within 48 hours of admission Add     
Gen Structures / Processes Process Japan Ca EOL Cancer patients NCP 1.2 Explanation of medical condition to patient or family Add     
Gen Structures / Processes Process Japan Ca EOL Cancer patients NCP 1.2 Explanation to family about course of disease until death Add     
Gen Structures / Processes Process RWJ CC Critical care unit patients NCP 1.2 Documentation that an interdisciplinary clinician-family conference occurred within 72 hours of admission and documentation of what was discussed Add     
Gen Structures / Processes Process RWJ CC Critical care unit patients NCP 1.2 Documentation of the goals of care in the patient’s chart within 72 hours Add     
Gen Structures / Processes Process RWJ CC Critical care unit patients NCP 1.2 Documentation of communication between a physician and a family member or friend of the patient within 24 hours of admission Add     
Gen Structures / Processes Process TICU PC Critical care unit patients NCP 1.2 Percentage of patients with documentation of an interdisciplinary meeting with the patient/family, in cases of ICU length of stay > 5 days Add     
Gen Structures / Processes Process UHC PC Adults with high-mortality diagnoses NCP 1.2 Documentation of a meeting between patient/family and members of the healthcare team to discuss the patient’s treatment preferences or the plans for discharge disposition, within 1 week of admission Add     
Gen Structures / Processes Process UHC PC Adults with high-mortality diagnoses NCP 1.2 Proportion of patients with discharge disposition plan documented within 4 days of admission Add     
Gen Structures / Processes Process UHC PC Adults with high-mortality diagnoses NCP 1.2 Proportion of patients with documentation that a discharge planner arranged for any needed home services Add     
Gen Structures / Processes Process Japan Ca EOL Cancer patients NCP 1.3 Documentation of discussion of strategy of care among physicians and nurses Add     
Physical Process ASSIST Cancer patients NCP 2.1 % inpatients with primary lung cancer or advanced cancer with dyspnea on admission who were offered symptomatic management or treatment directed at an underlying cause within 24 hours. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % inpatients with nausea or vomiting who were offered a change in therapy within 24 hours of the initial report of nausea or vomiting. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients in the hospital treated for dyspnea who had an assessment within 24 hours that the treatment was effective in relieving dyspnea or that a change in treatment for dyspnea was made. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % hospitalized patients with cancer over the age of 65 or with advanced cancer with delirium for whom there was an assessment for the presence or absence of at least one of the following potential causes and their association with delirium: medication effects, central nervous system disease, infection, or metabolic processes. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients who report nausea or vomiting on admission to the hospital for whom potential underlying causes were assessed within 24 hours. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients with advanced cancer affecting the gastrointestinal tract or abdomen admitted to a hospital for whom the presence or absence of nausea or vomiting was assessed within 24 hours. Add     
Physical Process ASSIST Cancer patients NCP 2.1 % patients admitted to the hospital who were screened for the presence or absence of pain. Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Physician’s prescription order for dyspnea Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Documentation of physician’s prescription order for pain management Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Documentation of presence or absence of dyspnea Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Observation and care of mouth Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Documentation of presence of absence of pain Add     
Physical Process Japan Ca EOL Cancer patients NCP 2.1 Documentation of the degree of pain Add     
Physical Process PEACE PC patients NCP 2.1 % patients on opioids for whom a bowel regimen is ordered Add     
Physical Process PEACE PC patients NCP 2.1 % patients on opioids who have a bowel regimen initiated within 1 day of opioid initiation Add     
Physical Process PEACE PC patients NCP 2.1 For patients who screened positive for constipation, % who receive treatment within 1 day of screening Add     
Physical Process PEACE PC patients NCP 2.1 For new ratings of shortness of breath ≥4 (on a ten-point scale) % with treatment (or indication of satisfaction with symptom) within 4 hours Add     
Physical Process PEACE PC patients NCP 2.1 For patients who screened positive for dyspnea, % who receive medication or non-medication treatment within 1 day of screening Add     
Physical Process PEACE PC patients NCP 2.1 For patients who screened positive for nausea, % who receive treatment within 1 day of screening Add     
Physical Process PEACE PC patients NCP 2.1 For patients who screened positive for moderate or severe pain on admission, % who had an order for pain medication within 1 day of screening Add     
Physical Process PEACE PC patients NCP 2.1 For seriously ill patients receiving specialty palliative care in an acute hospital setting >1 day who screened positive for moderate or severe pain on admission, % with medication or non-medication treatment within 24 hours of screening Add     
Physical Process PEACE PC patients NCP 2.1 For patients who screened positive for dyspnea, % who receive a 2nd assessment within 24 hours Add     
Physical Process PEACE PC patients NCP 2.1 % patients who were screened for dyspnea during the admission visit Add     
Physical Process PEACE PC patients NCP 2.1 For patients who screened positive for pain on admission, % with a clinical assessment within 1 day of screening Add     
Physical Process PEACE PC patients NCP 2.1 % of patients with cognitive and language problems receiving pain assessment appropriate to their communication needs Add     
Physical Process RWJ CC Critical care unit patients NCP 2.1 Documentation of treatment of pain that is assessed at >3 on a 0-10 scale or greater than mild on other scales, with reassessment after treatment Add     
Physical Process RWJ CC Critical care unit patients NCP 2.1 Documentation of treatment of or management plan for respiratory distress or patient-ventilator dyssynchrony that is assessed as >3 on a 0-10 scale or greater than mild on other scales with reassessment after treatment Add     
Physical Process RWJ CC Critical care unit patients NCP 2.1 Documentation of pain assessment every 4 hours Add     
Physical Process RWJ CC Critical care unit patients NCP 2.1 Documentation of respiratory distress assessment (for unventilated patients) or patient-ventilator dyssynchrony (for ventilated patients) every 8 hours Add     
Physical Process UHC PC Adults with high-mortality diagnoses NCP 2.1 Proportion of patients receiving opioids who had an order for a bowel regimen written within 24 hours of the order for the opioid Add     
Physical Process UHC PC Adults with high-mortality diagnoses NCP 2.1 Proportion of patients with dyspnea assessment within 48 hours of admission Add     
Physical Process UHC PC Adults with high-mortality diagnoses NCP 2.1 Documentation of pain assessment within 48 hours of admission Add     
Physical Process UHC PC Adults with high-mortality diagnoses NCP 2.1 Use of numeric pain scale Add     
Psychological / Psychiatric Process Japan Ca EOL Cancer patients NCP 3.1 Documentation of degree and content of patient’s anxiety Add     
Psychological / Psychiatric Process Japan Ca EOL Cancer patients NCP 3.1 Documentation of emotional reaction to explanation of medical condition Add     
Psychological / Psychiatric Process Japan Ca EOL Cancer patients NCP 3.1 Documentation of presence of absence of delirium or agitation Add     
Psychological / Psychiatric Process RWJ CC Critical care unit patients NCP 3.1 Documentation of offering the patient or family psychosocial support within the first 72 hours of admission Add     
Psychological / Psychiatric Process UHC PC Adults with high-mortality diagnoses NCP 3.1 Proportion of patients receiving a psychosocial assessment conducted by a psychologist, social worker, psychiatrist or other mental health expert completed within 4 days after admission (if an assessment had not been completed within the year prior to admission) Add     
Social Process Japan Ca EOL Cancer patients NCP 4.2 Documentation of configuration of family relationships Add     
Social Process Japan Ca EOL Cancer patients NCP 4.2 Documentation of coordination of social resources when patient had no family or friends Add     
Social Process TICU PC Critical care unit patients NCP 4.2 Percentage of patients with documentation that social work support was offered to the patient/family, in cases of ICU length of stay ≥ 3 days Add     
Spiritual Structure NQF PP PC patients NCP 5.3 Spiritual care is available through organizational spiritual counseling or through the patient’s own clergy relationships Add     
Spiritual Structure NQF PP PC patients NCP 5.3 The organization/program has established partnerships with community clergy Add     
Spiritual Process Japan Ca EOL Cancer patients NCP 5.2 Documentation of patient’s religion Add     
Spiritual Process RWJ CC Critical care unit patients NCP 5.2 Documentation that spiritual support was offered to family members within 72 hours of admission to the ICU Add     
Cultural Structure NQF PP PC patients NCP 6.1 Materials describing hospice and palliative care are available in the patient’s and family’s preferred language Add     
Cultural Process Japan Ca EOL Cancer patients NCP 6.1 Family’s preference of explanation of medical condition Add     
EOL Care Structure RWJ CC Critical care unit patients NCP 7.2 Presence of a protocol for provision of analgesia and sedation during terminal withdrawal of mechanical ventilation Add     
EOL Care Structure NQF PP PC patients NCP 7.3 Policies and procedures are in place that promote treating the body post-death with respect, according to the cultural and religious practices of the family and in accordance with local law Add     
EOL Care Process Japan Ca EOL Cancer patients NCP 7.1 Explanation to family 1 week prior to patient’s death Add     
EOL Care Process Japan Ca EOL Cancer patients NCP 7.1 Explanation to family of patient’s impending death Add     
EOL Care Process NQF PP PC patients NCP 7.1 Proportion of cases where the transition to the active dying phase was documented and communicated to the family Add     
EOL Care Process ACOVE Vulnerable elders NCP 7.2 IF a non-comatose vulnerable elder is not expected to survive, and a mechanical ventilator is withdrawn or withheld, THEN the chart should document whether the patient has dyspnea, and the patient should receive (or have orders available for) an opiate, benzodiazepine, or barbiturate infusion Add     
EOL Care Process ACOVE Vulnerable elders NCP 7.2 IF a vulnerable elder who had dyspnea in the last 7 days of life died an expected death, THEN the chart should document dyspnea care and follow-up Add     
EOL Care Process ACOVE Vulnerable elders NCP 7.2 IF a vulnerable elder who was conscious during the last 7 days of life died an expected death, THEN the medical record should contain documentation about presence or absence of pain during the last 7 days of life Add     
EOL Care Process RWJ CC Critical care unit patients NCP 7.2 Documentation of opiates, benzodiazepines or similar agents prescribed to manage distress or dyspnea for noncomotose patients undergoing terminal withdrawal of mechanical ventilation Add     
Ethical/legal Structure NQF PP PC patients NCP 8.1 Presence of policies, procedures and / or technology that promotes (appropriately secure) access to advance directives and surrogacy designations across settings Add     
Ethical/Legal Structure NQF PP PC patients NCP 8.2 Presence of processes to manage ethical aspects involving discordant patient, family, and caregiver goals and to handle disputes and uncertainties regarding a patient’s previously stated preferences and current family or proxy decisions Add     
Ethical/Legal Structure NQF PP PC patients NCP 8.2 Ethics consultation or an Ethics Committee is available to address ethical conflicts at the end of life Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 IF a vulnerable elder has documented treatment preferences to withhold or withdraw life-sustaining treatment (e.g., DNR order, no tube feeding, no hospital transfer) THEN these treatment preferences should be followed Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 IF a vulnerable elder with severe dementia is admitted to the hospital and survives 48 hours, THEN within 48 hours of admission, the medical record should document that the patient’s preferences for care have been considered or an attempt was made to identify them Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 IF a vulnerable elder has an advance directive in the outpatient, inpatient, or nursing home medical record, or the patient reports the existence of an advance directive in an interview, and the patient receives care in a second venue, THEN the advance directive should be present in the medical record at the second venue, or documentation should acknowledge its existence and its contents Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 IF a vulnerable elder is admitted to the ICU and survives 48 hours, THEN within 48 hours of ICU admission, the medical record should document that the patient’s preferences for care have been considered or an attempt was made to identify them Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 IF a vulnerable elder with decision-making capacity has orders in the hospital or nursing home to withhold or withdraw a life-sustaining treatment (e.g., DNR order), THEN the medical record should document patient participation in the decision or why the patient did not participate Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 IF a vulnerable elder is admitted to the hospital or nursing home, THEN within 48 hours of admission, the medical record should contain the patient’s surrogate decision maker or documentation of a discussion to identify or search for surrogate decision maker Add     
Ethical/Legal Process ACOVE Vulnerable elders NCP 8.1 IF a hospitalized vulnerable elder requires mechanical ventilation for longer than 48 hours, THEN within 48 hours of the initiation of mechanical ventilation, the medical record should document the goals of care and the patient’s preference for mechanical ventilation or why this information is unavailable Add     
Ethical/Legal Process ASSIST Cancer patients NCP 8.1 % patients with advanced cancer who are mechanically ventilated in the ICU for whom the patient's preference for mechanical ventilation or why this information was unavailable was documented in the medical record within 48 hours of admission to the ICU. Add     
Ethical/Legal Process ASSIST Cancer patients NCP 8.1 % patients with advanced cancer who are admitted to the ICU and survive 48 hours for whom the patient's preferences for care or an attempt to identify them was documented in the medical record within 48 hours of ICU admission. Add     
Ethical/Legal Process RWJ CC Critical care unit patients NCP 8.1 Documentation that the goals of care and resuscitation status are communicated to the receiving team on transfer of the patient out of the ICU Add     
Ethical/Legal Process RWJ CC Critical care unit patients NCP 8.1 Documentation of the presence or absence of an advance directive (AD: including living will or durable power of attorney for health care) and if present documentation of the contents of the AD or a copy of the AD Add     
Ethical/Legal Process RWJ CC Critical care unit patients NCP 8.1 Documentation of a surrogate decision maker or makers or documentation of the absence of surrogate decision maker within 24 hours of admission Add     
Ethical/Legal Process RWJ CC Critical care unit patients NCP 8.1 Assessment within 24 hours of admission of the patient’s decisional capacity Add     
Ethical/Legal Process TICU PC Critical care unit patients NCP 8.1 Percentage of patients with resuscitation status documented within 24 hours of admission Add     
Clinical/Pt-reported Outcome TICU PC Critical care unit patients NCP 2.1 Proportion of four hour intervals with documented pain score <3 on 1-10 scale (denominator is total number of 4 hour intervals of ICU days 0 or 1 for all patients admitted to the ICU in the prior 24 hours) Add     
Clinical/Pt-reported Outcome UHC PC Adults with high-mortality diagnoses NCP 2.1 Of patients reporting pain at admission, proportion where pain was relieved/reduced (to a score of 3 or less on a 0-10 scale) within 48 hours Add     
Clinical/Pt-reported Outcome UHC PC Adults with high-mortality diagnoses NCP 2.1 Of patients reporting dyspnea at admission, the proportion with dyspnea relieved or reduced (score of 3 or less on a 0-10 scale) within 48 hours of admission Add     
Operational Structure Common use PC service NA Care settings/models offered (inpatient consult, inpatient unit, home-based, nursing home, clinic, telephone/distance, etc.) Add     

Sources

Many of the metrics (and the source measure sets) included in the menu were identified in two recent systematic reviews:

Kamal AH, Gradison M, Maguire JM, Taylor D, Abernethy AP. Quality measures for palliative care in patients with cancer: a systematic review. J Oncol Pract. 2014 Jul;10(4):281-7.

De Roo ML, Leemans K, Claessen SJ, Cohen J, Pasman HR, Deliens L, Francke AL; EURO IMPACT. Quality indicators for palliative care: update of a systematic review. J Pain Symptom Manage. 2013 Oct;46(4):556-72).

In addition, the Menu includes metrics that address the National Quality Forum (NQF) National Framework and Preferred Practices for Palliative and Hospice Care Quality, pertinent metrics that are used or endorsed by regulatory or accreditation groups such as The Joint Commission and the National Committee for Quality Assurance (NCQA), and several that are used in Dartmouth Atlas of Healthcare, an important national benchmarking database. The Menu also includes several metrics that are sourced as “Common use”; these are metrics that the Menu authors know to be in use by palliative care programs, often for the purpose of describing operational activities, like the number of patients served or the timing of care delivery.

ACOVE
Description
Assessing Care of Vulnerable Elders (ACOVE): developed by RAND, a set of evidence-based indicators of quality of care delivered to vulnerable elders, which can be used to assess quality of care at the health system level.
Notes
Vulnerable elders, defined as community-dwelling individuals age 75 or over, as well as community dwelling individuals aged 65 and older who are at greater risk of death or functional decline over a 2-year period. The latter group is identified with the Vulnerable Elder Survey-13 (VES-13), a 13-item interview tool that addresses self-rated health and functional disabilities and limitations, yielding a score ranging from 0 (lowest risk) to 10 (highest risk) that predicts functional decline and death. Individuals with VES-13 scores of 3 or higher qualify as “vulnerable elders.”
Original Settings
All locations
References
Lorenz KA et al. Quality indicators for palliative and end-of-life care in vulnerable elders. J Am Geriatr Soc. 2007 Oct;55 Suppl 2:S318-26. Wenger NS, Shekelle PG (2001) Assessing care of vulnerable elders: ACOVE project overview. Ann Intern Med 135:642–646.
Links
ACOVE program description, research briefs and other publications are available at: http://www.rand.org/health/projects/acove.html The VES-13 survey tool is available at: http://www.rand.org/health/projects/acove/survey.html
AMA-PCPI NCQA
Description
Physician performance measures and related data specifications applicable to palliative care, developed by the American Medical Association (AMA) in collaboration with the Physician Consortium for Performance Improvement (PCPI) and the National Committee for Quality Assurance (NCQA). The measures were designed to promote individual quality improvement, though the developers state that the measures may also be used in data registries, continuing medical education programs, and in board certification programs.
Notes
Patients with advanced chronic or serious life threatening illnesses, defined as: Patients with incurable cancer, organ system failure, or severe progressive neurological conditions (identified with ICD-9 code) AND Patients with a substantial risk of death within one year, based on the physician’s clinical judgment integrating the patients co-morbidities, health status, social and other factors (identified with CPT-II code) OR Patients with advanced disease whose goals of care prioritize comfort (identified with CPT-II code). The document describing the measure (available free from the AMA web site, with registration) includes a detailed list of ICD-9 and CPT codes used to identify the target patient population.
Original Settings
All locations
References
Wenger N, et al. American Medical Association - Physician Consortium on Performance Improvement palliative and end of life care physician performance measurement set. 2008.
Links
A detailed document describing the measure and methods for defining the numerator and denominator is available on the AMA web site (free, but registration required; scroll down the list of Measure Topics to find "Palliative Care"): http://www.ama-assn.org/apps/listserv/x-check/qmeasure.cgi?submit=PCPI
ASCO/QOPI
Description
The American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) is a benchmarking and quality improvement collaborative for oncology practices. The QOPI program utilizes a library of quality measures developed by oncologists and quality experts. The library includes measures that address palliative care and end-of-life care.
Notes
Patients with cancer
Original Settings
Outpatient oncology practices
References
Campion FX, et al. (2011) Advancing performance measurement in oncology: Quality Oncology Practice Initiative participation and quality outcomes. J Oncol Pract 7:31s–35s. Earle CC, Park ER, Lai B, Weeks JC, Ayanian JZ, Block S. Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol. 2003 Mar 15;21(6):1133-8 Earle CC, Neville BA, Landrum MB, Souza JM, Weeks JC, Block SD, Grunfeld E, Ayanian JZ. Evaluating claims-based indicators of the intensity of end-of-life cancer care. Int J Qual Health Care. 2005 Dec;17(6):505-9
Links
A description of the QOPI program and a catalogue of measures is available at: http://www.instituteforquality.org/qopi/measures Several QOPI measures are modifications of NQF endorsed measures addressing quality of end-of-life care for cancer patients. The NQF measures can be reviewed via the Quality Positioning System (just enter the measure number to review a detailed description of measure attributes and uses): http://www.qualityforum.org/QPS/QPSTool.aspx
ASSIST
Description
Cancer Quality-ASSIST (Addressing Symptoms, Side Effects, and Indicators of Supportive Treatment): developed by RAND, a comprehensive set of quality indicators for evaluating pain and non-pain symptom management as well as care planning needs for cancer patients.
Notes
The ASSIST indicators were developed to assess the quality of supportive care provided to adults living with cancer (excluding individuals who had been cancer-free for six months or more.) The indicators can be used across the clinical sites where cancer patients seek care (ambulatory and inpatient), for care provided by both general practitioners and oncology specialists.
Original Settings
All locations
References
Lorenz KA et al. (2009) Quality Measures for Supportive Cancer Care: The Cancer Quality-ASSIST Project. J Pain Symptom Manage 37(6):943-64 Dy SM, et al. (2010) Cancer Quality-ASSIST supportive oncology quality indicator set: Feasibility, reliability, and validity testing. Cancer 116:3267–3275.
Links
ASSIST measures are listed in the Agency for Healthcare Research and Quality's National Quality Measure Clearinghouse: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?orgid=2198&objid=25919
CANADA Ca EOL
Description
Grunfeld et al. evaluated the feasibility of using routinely collected administrative data to measure population-based indicators of quality end-of-life care. The study utilized data describing health care use patterns in the last 6 months of life among Canadian women with breast cancer. 14 quality indicators were deemed to be fully or partially measureable across two Canadian provinces, all of which are listed in the PC Measure Menu (seven of the indicators are attributed to the "Canada Ca EOL" measure set, seven others can be found in the Dartmouth Atlas or ASCO/QOPI measure sets.)
Notes
Women who died of breast cancer, but the measures are certainly appropriate for all other types of cancers and many would be useful for assessing utilization among non-cancer patients.
Original Settings
All locations
References
Grunfeld E, et al. (2006) Towards using administrative databases to measure population-based indicators of quality of end-of-life care: Testing the methodology. Palliat Med 20:769–777. Grunfeld E, et al. Toward population-based indicators of quality end-of-life care: testing stakeholder agreement. Cancer. 2008 May 15;112(10):2301-8. Cheung MC, et al. Impact of Aggressive Management and Palliative Care on Cancer Costs in the Final Month of Life. Cancer. 2015 May 29. doi: 10.1002/cncr.29485. [Epub ahead of print]
Links
CAPC
Description
The Center to Advance Palliative Care (CAPC) is a national, member-based organization that provides hospitals, health systems, hospices, payers and other healthcare organizations with tools, training, technical assistance and metrics that support implementation and integration of palliative care. CAPC published several sets of recommendations, based on expert consensus, addressing operational, clinical and satisfaction metrics for specialty palliative care programs.
Notes
All persons being seen by a PC service; mostly applicable to inpatient consultation services
Original Settings
Hospital, but some recommendations are applicable to palliative care delivered in other settings
References
Weissman DE, Meier DE (2008) Center to Advance Palliative Care Palliative Operational features for hospital palliative care programs: Consensus recommendations. J Palliat Med 11:1189–1194. Weissman DE, et al. (2008) Center to Advance Palliative Care Palliative Care Consultation Service Metrics: Consensus Recommendations. J Palliat Med 11:1294-8 Weissman DE, et al. (2010) Center to Advance Palliative Care palliative care clinical care and customer satisfaction metrics consensus recommendations. J Palliat Med 13:179–184.
Links
Information about CAPC: https://www.capc.org/
CMS
Description
Through its Value-Based Purchasing (VBP) Program, the Centers for Medicare & Medicaid Services (CMS) increases or reduces payments to acute-care hospitals based on performance on process measures, outcome measures and patient satisfaction. 30-day mortality rates for CHF, AMI and pneumonia are included in the calculation. While a PC service could not impact hospital-wide performance on the 30-day mortality measure, it is very likely that some near death admissions could be avoided through better outpatient and home-based care. Monitoring the extent to which patients cared for by a community-based PC program use the acute care hospital in the month preceding death could be an important opportunity for demonstrating the utilization/fiscal impact of a specialty program.
Notes
Individuals with AMI, CHF or pneumonia who die within 30 days of hospital admission
Original Settings
Hospital
References
Links
Information about the VBP is available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html
Common use
Description
Metrics and indicators known by the PC Measure Menu developers to be in use by specialty PC programs, health systems and other provider groups and payers.
Notes
Varied
Original Settings
Varied
References
Links
NA
Dartmouth Atlas
Description
The Dartmouth Atlas of Healthcare, developed and maintained by The Dartmouth Institute for Health Policy and Clinical Practice, includes information, a searchable database, and customizable reporting tools on health care performance across the country, including subtopics on care of chronic illness in the last two years of life and end-of-life care. Where the needed data are available, replicating the indicators presented in the Dartmouth Atlas with other patient populations can be extremely useful.
Notes
All data are for Medicare Fee-For-Service (FFS) beneficiaries. Pertinent information is available for three groups: 1) individuals with chronic illness in the last two years of life (cancer/leukemia, CHF, chronic pulmonary disease, dementia, diabetes w end organ damage, peripheral vascular disease, chronic renal failure, severe chronic liver disease, coronary artery disease) 2) individuals with cancer 3) all decedents
Original Settings
All locations
References
The data presented in the Dartmouth Atlas map to indicators described in the references sited for the ASCO/QOPI and Canada Ca EOL measure sets.
Links
Dartmouth Atlas of Healthcare http://www.dartmouthatlas.org/data/topic/
Japan Ca EOL
Description
Miyashita et al. identified 30 quality indicators for end-of-life care delivered to cancer patients in Japan. The research team identified processes and outcomes that would be documented in the medical chart upon admission to a hospital, or in the last two weeks of life. 18 of the measures were deemed to be specific enough to include in the PC Measure Menu
Notes
Patients with advanced cancer receiving care in Japan
Original Settings
All locations
References
Miyashita M, et al. (2008) Identification of quality indicators of end-of-life cancer care from medical chart review using a modified Delphi method in Japan. Am J Hosp Palliat Care 25:33–38.
Links
Joint Commission
Description
The Joint Commission has two Heart Failure Standardized Performance Measures that are utilized in their Advanced Certification program
Notes
All individuals with heart failure
Original Settings
All locations
References
Lindenfeld J, et al. Executive summary: HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010;16:475-539
Links
The Joint Commission measures are listed in the Agency for Healthcare Research and Quality's National Quality Measure Clearinghouse: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?orgid=10&objid=48914
NCP
Description
Developed by the National Consensus Project, the Clinical Practice Guidelines for Quality Palliative Care, 3rd edition, outline consensus best practices and essential elements of palliative care programs, across 8 domains. We use "NCP" as a source reference when a structure or process included in the guidelines has not been addressed in one of the other source measure sets.
Notes
Individuals with serious illness who receive palliative care
Original Settings
All locations
References
The guidelines and supporting criteria are replicated in the "NCP Guidelines" tab of the PC Measure Menu.
Links
The full text of NCP's Clinical Practice Guidelines for Quality Palliative Care, 3rd edition can be accessed from: http://www.nationalconsensusproject.org/Guidelines_Download2.aspx
NCQA
Description
The National Committee for Quality Assurance (NCQA) is a private, not-for-profit organization that develops standards and performance measures for a broad range of health care entities. One measure addressing advance care planning is included in NCQA’s Geriatrics Physician Performance Measurement Set
Notes
Patients age 65 and over
Original Settings
All locations
References
American Geriatrics Society, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Geriatrics physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2009 Jul.
Links
Information about NCQA: http://www.ncqa.org/ Details of the Geriatrics Physician Performance Measurement Set are available in the Agency for Healthcare Research and Quality's National Quality Measure Clearinghouse: http://www.qualitymeasures.ahrq.gov/content.aspx?id=28108
Netherlands PC
Description
Claessen et al. developed and tested of a set of 33 quality indicators for palliative care, applicable for all settings in which palliative care is being provided to adult patients in The Netherlands. The PC Measure Menu includes the 25 indicators that address the patient and family experience of care. These indicators are to be measured with the CQ-index Palliative Care (CQ-index PC). The patient version of the CQ Index PC asks about physical, psychosocial, spiritual well-being, respecting independence, respecting privacy, information and expertise of caregivers. Patients were asked to complete the CQ-index PC based on their experiences with the care delivered in the previous week by the care institution from which they received the questionnaire. The relative version of the CQ Index PC measures perceptions of care quality delivered to the patient and to the family. Bereaved relatives who received the CQ-index PC relative version were asked to complete the questionnaire by taking into account the care received from the last health care institution involved in their loved one's care.
Notes
Adult patients receiving palliative care in the Netherlands.
Original Settings
All locations
References
Claessen SJ, et al. (2011) A new set of quality indicators for palliative care: Process and results of the development trajectory. J Pain Symptom Manage 42:169–182. Claessen SJ, et al. Measuring Relatives’ Perspectives on the Quality of Palliative Care: The Consumer Quality Index Palliative Care. J Pain Symptom Manage 2013;45:875e884. Claessen SJ, et al. Measuring patients’ experiences with palliative care: the Consumer Quality Index Palliative Care. BMJ Supportive and Palliative Care: 2012, 2(4), 367-372
Links
The survey tools are replicated in the references
NQF PP
Description
The National Quality Forum (NQF), with support from the Robert Wood Johnson Foundation and the Department of Veterans Affairs, developed and endorsed 38 preferred practices deemed to be suitable for implementation by palliative care and hospice programs. The framework and practices were derived from NCP’s eight domains of quality palliative and hospice care.
Notes
Patients receiving care from a palliative care service
Original Settings
All locations
References
A National Framework and Preferred Practices for Palliative and Hospice Care Quality. Available at: http://www.qualityforum.org/Publications/2006/12/A_National_Framework_and_Preferred_Practices_for_Palliative_and_Hospice_Care_Quality.aspx
Links
Information about the National Quality Forum: http://www.qualityforum.org/Home.aspx
PEACE
Description
Prepare, Embrace, Attend, Communicate, Empower (PEACE): developed by The Carolinas Center for Medical Excellence (CCME) and the University of North Carolina-Chapel Hill, under contract to the Centers for Medicare & Medicaid Services (CMS), a set of palliative care quality measures tested for feasibility, usability and reliability. The three PEACE metrics that address the family experience of care could be assessed with the Family Evaluation of Palliative Care survey, which was endorsed as a candidate global measure by the MWM initiative.
Notes
The PEACE measures were originally designed to allow hospices and PC programs to assess the quality of care they provide, regardless of setting. Some PEACE measures have been tested/adapted to apply to a more specific subset of patients. For the PEACE measures included in the MWM recommendations and those are NQF endorsed, the population was defined as "seriously ill patients receiving specialty palliative care in an acute care hospital setting (admitted for >1 day)." The 17 PEACE measures tested in the Hanson study were applied to a population of "seriously ill hospitalized patients," including those who did and did not receive care from a palliative care service.
Original Settings
All locations
References
Schenck AP, et al: The PEACE Project: Identification of quality measures for hospice and palliative care. J Palliat Med 13:1451-1459, 2010 Hanson LC, et al. Measuring palliative care quality for seriously ill hospitalized patients. J Pall Med, 2012; 15(7): 798-804.
Links
PEACE program description, data collection tools, measure specifications and other resources are available at: http://www.med.unc.edu/pcare/resources/PEACE-Quality-Measures The Family Evaluation of Palliative Care survey and supporting tools is available from the NHPCO web site: http://www.nhpco.org/performance-measures/family-evaluation-palliative-care-fepc
RWJ CC
Description
Developed by the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup, 18 quality measures that can be used to assess palliative care delivered to critically ill individuals.
Notes
All populations
Original Settings
Critical care units
References
Mularski RA, et al. Proposed quality measures for palliative care in the critically ill: a consensus from the Robert Wood Johnson Foundation Critical Care Workgroup. Crit Care Med. 2006 Nov;34(11 Suppl):S404-11 Clarke EB, et al. Quality indicators for end-of-life care in the intensive care unit. Crit Care Med. 2003 Sep;31(9):2255-62
Links
TICU PC
Description
Developed as part of the national ‘‘Transformation of the ICU’’ (TICU) program, a performance improvement initiative through VHA Inc., a set of 10 process measures that can be used to assess the quality of ICU palliative care. In the PC Measure Menu fIve of the ten TICU PC indicators can be found in the RWJ CC measure set (the indicators are featured in both measures sets and are not duplicated in the PC Measure Menu)
Notes
All populations
Original Settings
Critical care units
References
Nelson JE, et al. Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback. Qual Saf Health Care. 2006 Aug;15(4):264-71 Clarke EB, et al. Quality indicators for end-of-life care in the intensive care unit. Crit Care Med. 2003 Sep;31(9):2255-62
Links
The 10 TICU measures (identified as those addressing "Care and Communication") are listed in the Agency for Healthcare Research and Quality's National Quality Measure Clearinghouse: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?objid=25944
UHC PC
Description
11 measures used in a 35-site study of palliative care quality sponsored by the University Healthsystem Consortium (UHC), a collaborative of academic medical centers.
Notes
Adult patients with “high mortality diagnoses,” defined as heart failure, selected cancers, human immunodeficiency virus (HIV), and respiratory failure. To capture patients who were more likely to have advanced conditions that might benefit from palliative care, additional enrollment criteria included a length of stay (LOS) greater than 4 days and at least 2 previous hospital admissions for any cause within the 12 months prior to the studied admission
Original Settings
Academic medical centers
References
Twaddle ML, et al. Palliative care benchmarks from academic medical centers. J Palliat Med. 2007 Feb;10(1):86-98 Full text is available free from ResearchGate: http://www.researchgate.net/publication/6507634_Palliative_care_benchmarks_from_academic_medical_centers
Links
More information about UHC is available at: https://www.uhc.edu/index

NCP Guidelines

Each Structure and Process metric in the Menu is linked to a specific guideline or guideline criterion described in the National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care, 3rd edition (available as a free download from: http://www.nationalconsensusproject.org/Guidelines_Download2.aspx). The guidelines and criteria are replicated here.

Number Guideline And Criteria Domain
1.1 Guideline: A comprehensive and timely interdisciplinary assessment of the patient and family forms the basis of the plan of care. STRUCTURE AND PROCESSES OF CARE
• Palliative assessment and documentation are interdisciplinary and coordinated.
• The interdisciplinary team (IDT) completes an initial comprehensive assessment and subsequent reevaluation through patient and family interviews, review of medical and other available records, discussion with other providers, physical examination and assessment, along with relevant laboratory and/or diagnostic tests or procedures.
• An initial evaluation includes: the patient's current medical status; adequacy of diagnosis and treatment consistent with review of past history; diagnosis and treatment; and responses to past treatments.
• Assessment includes documentation of disease status: diagnoses and prognosis; comorbid medical and psychiatric disorders; physical and psychological symptoms; functional status; social, cultural, and spiritual strengths, values, practices, concerns, and goals; advance care planning concerns, preferences, and documents; and appropriateness of hospice referral
• Assessment of neonates, children, and adolescents must be conducted with consideration of age and stage of neurocognitive development.
• The IDT documents assessment of the patient and family perception and understanding of the serious or life limiting illness including: patient and family expectations of treatment, goals for care, quality of life, as well as preferences for the type and site of care.
• Comprehensive assessment identifies the elements of quality of life. Quality of life is defined by four domains: physical, psychological, social, and spiritual aspects of care. Interventions are focused to alleviate distress in one or any of these domains.
• This comprehensive assessment recurs on a regular basis and in subsequent intervals, or in response to significant changes in the patient's status or the patient and family's goals.
1.2 Guideline: The care plan is based on the identified and expressed preferences, values, goals, and needs of the patient and family and is developed with professional guidance and support for patient­family decision making. Family is defined by the patient. STRUCTURE AND PROCESSES OF CARE
• The care plan is based upon an ongoing assessment and reflects goals set by the patient, family or surrogate in collaboration with the IDT. Such goals reflect the changing benefits and burdens of various care options, at critical decision points during the course of illness.
• In collaboration with the patient, family, and other involved health care professionals, the IDT develops the care plan with the additional input, when indicated, from other community providers such as school professionals, community service providers, and spiritual leaders.
• Changes in the care plan are based on the evolving needs and preferences of the patient and family, with recognition of the complex, competing, and shifting priorities in goals of care. The evolving care plan is documented over time.
• The IDT supports patient-family decision making and then develops, implements, and coordinates the care plan in collaboration with the patient and family. The team promotes patient and family education and assures communication of the care plan to all involved health professionals. Particular attention is necessary when a patient transfers to a different care setting, with the imperative to communicate with the receiving provider.
• Treatment and care setting alternatives are clearly documented and communicated to the patient and family in a manner that promotes informed decision making.
• Treatment decisions are based on goals of care established by the patient, family, and IDT; assessment of risk and benefit; and best evidence. Reevaluation of treatment efficacy, patient-family goals, and choices are documented.
• Complementary and alternative therapies may be included in the plan of care.
1.3 Guideline: An interdisciplinary team (IDT) provides services to the patient and family consistent with the care plan. In addition to chaplains, nurses, physicians, and social workers, other therapeutic disciplines who provide palliative care services to patients and families may include: child-life specialists, nursing assistants, nutritionists, occupational therapists, recreational therapists, respiratory therapists, pharmacists, physical therapists, massage, art, and music therapists, psychologists, and speech and language pathologists. STRUCTURE AND PROCESSES OF CARE
• Specialist-level palliative care is delivered by an IDT.
• The patient and family have access to palliative care expertise and staff 24 hours a day, seven days a week. Respite services are available for the families caring for neonates, children, adolescents, or adults with serious or life-threatening illnesses.
• The team includes palliative care professionals with the appropriate patient population specific education, credentialing, and experience, and the skills to meet the physical, psychological, social, and spiritual needs of both patient and family. Of particular importance is assembling a team which includes chaplains, nurses, pharmacists, physicians, and social workers, appropriately trained and ideally, certified in hospice and palliative care, when such certification is available. The interdisciplinary palliative care team involved in the care of children, whether the child is a patient or a family member of either an adult or pediatric patient, has expertise in the delivery of services for such children.
• The IDT communicates regularly (at least weekly or more often as required by the clinical situation) to plan, review, evaluate, and update the care plan, with input from both the patient and family.
• The team meets regularly to discuss provision of quality care, including staffing, policies, measurement of quality and quality improvement, and clinical practices.
• Policies are in place for prioritizing and responding to referrals and patient-family crises in a timely manner.
1.4 Guideline: The palliative care program is encouraged to use appropriately trained and supervised volunteers to the extent feasible STRUCTURE AND PROCESSES OF CARE
• For programs utilizing volunteers, policies and procedures are in place to ensure safe, quality volunteer programs including: recruitment, screening (including background checks), training, job descriptions and role clarification, work practices, support, supervision, and performance evaluation.
• A program that uses volunteers has policies and procedures outlining the program's responsibilities to its volunteers.
• An appropriately educated and experienced professional team member screens, educates, coordinates, and supervises volunteers.
1.5 Guideline: Support for education, training, and professional development is available to the interdisciplinary team. STRUCTURE AND PROCESSES OF CARE
• The palliative care program supports each individual team member's professional development through mentorships, preceptorships, and supervision.
• Palliative care staff members participate in necessary continuing palliative care education within the eight domains, and document their participation accordingly. Educational resources, focused on the domains listed in this document, are available and provided to staff.
• Palliative care programs ensure appropriate levels of education for all palliative care professionals.
• Advanced practice nurses, physicians, and rehabilitation therapists, must have graduate degrees in their respective disciplines, with appropriate professional experience in hospice and palliative care. Chaplains and social workers must have a bachelor's degree and/or graduate degree in their respective disciplines from accredited schools and appropriate professional experience in hospice and palliative care or a related health care field. Specific education requirements do not apply to registered nurses, nursing assistants, personal care attendants, and/or volunteers.
• Palliative care programs encourage discipline-specific certification, or other recognition of competence, as part of the educational support for the interdisciplinary team. Education, resources, and support are provided specifically to enhance IDT communication and collaboration.
• Education is available to support team leadership including effective team management, human resource management, budgets and strategic planning.
1.6 Guideline: In its commitment to quality assessment and performance improvement, the palliative care program develops, implements, and maintains an ongoing data driven process that reflects the complexity of the organization and focuses on palliative care outcomes. STRUCTURE AND PROCESSES OF CARE
• The palliative care program commits to the pursuit of excellence and the highest quality of care and support for all patients and their families. The program determines quality by regular and systematic measurement, analysis, review, evaluation, goal setting, and revision of the processes and outcomes of care.
• Care is coordinated and consistently focused on the illness trajectory, which offers the right care at the right time, in the course of an individual's disease or condition.
• Quality care follows the national quality strategy set forth by the US Department of Health and Human Services described in the following provisions of the Affordable Care Act. These strategies include: Making care safer by reducing harm caused in the delivery of care; Ensuring that each person and family is engaged as partners in their care; Promoting effective communication and coordination of care; Promoting the most effective treatment practices for the leading causes of mortality, starting with cardiovascular disease; Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.
• A quality assessment and performance improvement (QAPI) review is conducted across all the domains, including organizational structure, education, team utilization, and assessment. This review includes effectiveness of physical, psychological, psychiatric, social, spiritual, cultural, and ethical assessment and interventions to manage these aspects of care.
• From this QAPI process, the palliative care program establishes quality improvement policies and procedures.
• A documented process for quality improvement leads to change in clinical practice. Quality improvement projects might include the development and testing of screening, history, and assessment tools, and appropriate protocols for diagnoses, interventions and outcomes.
• Quality improvement activities are routine, regular, reported, and demonstrate influence upon clinical practice. Designated staff, with experience in QAPI planning, direct the QAPI process in collaboration with leaders of the palliative care program.
• The clinical practice of palliative care reflects the integration and dissemination of current evidence and is based on QAPI.
• Quality improvement activities for clinical services are collaborative, interdisciplinary, and focused on meeting the identified needs and goals of patients and their families.
• Patients, families, health professionals, and the community participate in evaluation of the palliative care program.
1.7 Guideline: The palliative care program recognizes the emotional impact of the provision of palliative care on the team providing care to patients with serious or life-threatening illnesses and their families. STRUCTURE AND PROCESSES OF CARE
• The program provides emotional support to their administrative staff, IDT, and volunteers in coping with the stress of caring for individuals and families affected by serious or life-threatening illness.
• Support structure for staff and volunteers includes regular meetings during which the impact and processes of the provision of palliative care are discussed.
• The program and IDT implements interventions to promote staff support and sustainability.
1.8 Guideline: Community resources ensure continuity of the highest quality palliative care across the care continuum. STRUCTURE AND PROCESSES OF CARE
• Palliative care programs support and promote continuity of care throughout the illness trajectory across all settings.
• Non-hospice palliative care programs have a relationship with one or more hospices and other community resources to ensure continuity of the highest-quality palliative care across the care continuum.
• Non-hospice palliative care programs routinely inform patients and families about hospice and other community based healthcare resources, when such resources are consistent with the patient's and family's values, beliefs, preferences, and goals of care. Referrals are made only with patient and family consent.
• Policies enable timely and effective sharing of information among health care teams while safeguarding privacy.
• Referring clinicians (advanced practice registered nurses, physicians, and physician assistants) as defined by The Centers for Medicare & Medicaid Services and primary physicians are routinely informed about the availability and benefits of hospice, as well as other appropriate community resources for their patients and families. Early discussion of hospice and palliative services and early referral to such programs is facilitated by hospices and community resources.
• Hospice programs, non-hospice palliative care programs, and other major community service providers involved in the patient's care, establish policies for formal written and verbal communication among and between clinicians involved in the patient and family's care.
• When possible, hospice and palliative care program staff participate in each other's team meetings to promote regular professional communication, collaboration, and an integrated plan of care on behalf of patients and families.
• Hospice and palliative programs, as well as other major community providers, routinely seek opportunities to collaborate and partner to increase access to quality palliative care across the continuum.
1.9 Guideline: The physical environment in which care is provided meets the preferences, needs, and circumstances of the pt. & family, to the extent possible. STRUCTURE AND PROCESSES OF CARE
• When feasible, care occurs in the setting preferred by the patient and his or her family.
• When care is provided outside the patient's or family's home, the IDT collaborates with residential service providers to maximize the patient's safety and sense of control. Flexible visiting hours, as appropriate, occur to promote patient social interaction. A space is arranged for families to visit, rest, prepare or eat meals, along with other needs identified by the family. The environment also provides privacy to meet with palliative care providers and other professionals.
• Providers, in all settings, address the unique care needs of neonates, children, and adolescents whether they are patients, family members, or visitors.
2.1 Guideline: The interdisciplinary team assesses and manages pain and/or other physical symptoms and their subsequent effects based upon the best available evidence. PHYSICAL ASPECTS OF CARE
• The palliative care team regularly documents ongoing assessment of pain, other physical symptoms, and functional capacity. Validated symptom assessment instruments are utilized when available. Symptom assessment of adults with cognitive impairment and of neonates, children, or adolescents is performed by appropriately trained professionals using available validated instruments.
• Treatment of distressing symptoms and side effects includes the entire spectrum of pharmacological, interventional, behavioral, and complementary therapies/interventions, supported by efficacy research, with referral to appropriate specialists.
• Symptom assessment, treatment, side effects, and treatment outcome information is recorded in the medical record and transmitted across health care settings during transitions.
• Barriers related to the use of opioid analgesics are assessed and addressed with attention to misconceptions of side effect risks, the potential for addiction, respiratory depression, and hastening of death.
• Opioid prescribers develop an opioid analgesic risk assessment and management plan consistent with state and federal regulations for use with patients requiring long term opioid therapy for chronic pain syndromes. Patients, families, and/or other involved health providers are instructed about safe usage of opioids including: driving, operation of machinery, appropriate and safe storage, inventory and appropriate opioid disposal.
2.2 Guideline: The assessment and management of symptoms and side effects are contextualized to the disease status. PHYSICAL ASPECTS OF CARE
• Treatment plans for physical symptoms are developed in the context of the disease, prognosis, and patient functional limitations. The patient, family or surrogate's understanding of the illness is assessed in relation to patient-centered goals of care.
• Patient understanding of disease and its consequences, symptoms, side effects of treatments, functional impairment, and potentially useful treatments is assessed with consideration of culture, cognitive function, and developmental stage.
• Family or surrogate understanding of the disease and its consequences, symptoms, side effects, functional impairment, and treatments is assessed.
• Family and other health care providers are educated and supported to provide safe and appropriate care to the patient. The family is provided with resources for response to urgent needs.
3.1 Guideline: The interdisciplinary team assesses and addresses psychological and psychiatric aspects of care based upon the best available evidence to maximize patient and family coping and quality of life. PSYCHOLOGICAL AND PSYCHIATRIC ASPECTS OF CARE
• The IDT includes professionals with skills and training in the potential psychological and psychiatric impact of serious or life threatening illness, on both the patient and family including depression, anxiety, delirium, and cognitive impairment.
• Based on patient and family goals of care, interventions include assessing psychological needs, treating psychiatric diagnoses, and promoting adjustment to the physical condition or illness. The IDT supports opportunities for emotional growth, psychological healing, cognitive reframing, completion of unfinished business from diagnosis of a serious and life threatening illness through the bereavement period.
• Regular, ongoing assessment of psychological reactions related to the illness (including but not limited to stress, coping strategies, and anticipatory grieving), and psychiatric conditions is documented. Whenever possible and appropriate, a validated and context-specific assessment tool is used.
• Psychological assessment and treatment includes patient and family education about the disease or condition, symptoms, side effects, and treatments, as well as caregiving needs, decision making capacity, and coping strategies.
• The IDT effectively treats psychiatric diagnoses, such as depression, suicidal ideation, anxiety, delirium, whether a consequence of the illness or among patients with comorbid psychiatric illness accompanying their serious or life-threatening illness.
• Family education includes the provision of safe and appropriate psychological measures supportive to the patient.
• The IDT skillfully communicates and documents discussions concerning treatment alternatives, promoting informed patient and family decision making.
• The palliative care team response to psychological distress and psychiatric syndromes is prompt, effective, and reflects patient/family choice. Interventions are based on IDT assessment and informed by evidence based practice and may include pharmacologic, non-pharmacologic, and complementary therapies.
• Regular reassessment of treatment efficacy, response to treatment, and patient-family preferences is performed and consistently documented.
• Referrals to appropriate healthcare professionals with specialized skills in age-appropriate psychological and psychiatric treatment are available (e.g. psychiatrists, psychologists, and social workers). Identified psychiatric comorbidities present in family members are appropriately referred for treatment.
• The team performs a developmentally appropriate assessment and supports pediatric patients and children of family members of pediatric or adult patients.
• Patient and professional communication occurs using verbal, nonverbal, and/or symbolic means appropriate to the patient, with particular attention to patients with cognitive impairment and the developmental stage and cognitive capacity of neonates, children, and adolescents.
• Staff education includes recognition and treatment of common psychological and psychiatric syndromes (e.g. anxiety, depression, delirium, hopelessness, suicidal ideation, and substance withdrawal symptoms) as well as professional coping strategies to manage anticipatory grief and loss.
3.2 Guideline: A core component of the PC program is a grief and bereavement program available to patients and families, based on assessment of need. PSYCHOLOGICAL AND PSYCHIATRIC ASPECTS OF CARE
• The IDT includes professionals with patient population appropriate education and skill in the care of patients, families, and staff experiencing loss, grief, and bereavement.
• The identification and recognition of loss and grief in patients and families living with serious or life- threatening illness begins at diagnosis. Ongoing assessment and reassessment occurs throughout the illness trajectory.
• Staff and volunteers, including those who provide bereavement services, receive ongoing education, supervision, support in coping with their own grief, and guidelines to effectively respond to patients' and families' grief.
• At time of admission to hospice or a palliative care program, an initial, developmentally appropriate, professional assessment is completed to identify patients and families at risk for complicated grief, bereavement, and comorbid complications, particularly among older adults.
• Identified patients and families at risk for complicated grief and bereavement receive intensive psychosocial support, and prompt referral to appropriate professionals as needed.
• Bereavement services and follow-up are available to the family for a minimum of 12 months, after the death of the patient.
• Culturally and linguistically appropriate information on loss, grief, and the availability of bereavement services is routinely communicated to the family before and after the death of the patient. Such community services include support groups, counselors and collaborative partnerships with hospice.
• The IDT provides grief support and promotes interventions which are in accordance with developmental, cultural, and spiritual needs and the expectations and preferences of the family, with attention to children who are family members of any patient.
4.1 Guideline The interdisciplinary team assesses and addresses the social aspects of care to meet patient-family needs, promote patient-family goals, and maximize patient-family strengths and well­being. SOCIAL ASPECTS OF CARE
• The IDT facilitates and enhances: Patient-family understanding of, and coping with, illness and grief; Support for patient-family decision making; Discussion of the patient's and family's goals for care; Provision of emotional and social support; Communication within the family and between patient-family and the IDT.
• The IDT includes a social worker with patient population specific skills in assessment and interventions in order to address social needs during a life-threatening or serious illness.
• Health professionals with expertise in the developmental needs and capacities of neonates, children, and adolescents assess and intervene in the care of pediatric patients and child family members of pediatric or adult patients.
4.2 Guideline: A comprehensive, person-centered interdisciplinary assessment identifies the social strengths, needs, and goals of each patient and family. SOCIAL ASPECTS OF CARE
• The IDT assesses and documents the elements of a social assessment that includes: Family structure and function: roles, communication and decision making patterns; Strengths and vulnerabilities: resiliency; social and cultural support networks ;effect of illness or injury on intimacy and sexual expression; prior experiences with illness, disability, and loss; risk of abuse, neglect, or exploitation; Changes in family members' schooling, employment or vocational roles, recreational activities, and economic security; Geographic location, living arrangements, and perceived suitability of the living environment; Patient's and family's perceptions about caregiving needs, availability, and capacity; Needs for adaptive equipment, home modifications, transportation; Access to medications (prescription and over-the-counter) and nutritional products; Need for and access to community resources, financial support, and respite; Advance care planning and legal concerns.
• The social care plan reflects the patient's and family's culture, values, strengths, goals, and preferences, which may change over time.
• The IDT implements interventions to maximize the social well-being and coping skills of both the patient and family, including education and family meetings.
• The IDT refers the patient and family to appropriate resources and services that both address the patient's and family's identified social needs and goals, and maximize patient-family strengths.
5.1 Guideline: The interdisciplinary team assesses and addresses spiritual, religious, and existential dimensions of care. SPIRITUAL, RELIGIOUS AND EXISTENTIAL ASPECTS OF CARE
• Key principles: Spirituality is recognized as a fundamental aspect of compassionate, patient and family centered care that honors the dignity of all persons; Spirituality is defined as, “the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and/or to the significant or sacred." It is the responsibility of all lDT members to recognize spiritual distress and attend to the patient's and the family's spiritual needs, within their practice; Communication with the patient and family is respectful of their religious and spiritual beliefs, rituals, and practices. Palliative care team members do not impose their individual spiritual, religious, existential beliefs or practices on patients, families, or colleagues.
• The interdisciplinary palliative care team, in all settings, includes spiritual care professionals; ideally a board certified professional chaplain, with skill and expertise to assess and address spiritual and existential issues frequently confronted by pediatric and adult patients with life-threatening or serious illnesses and their families.
5.2 Guideline: A spiritual assessment process, including a spiritual screening, history questions, and a full spiritual assessment as indicated, is performed. This assessment identifies religious or spiritual/existential background, preferences, and related beliefs, rituals, and practices of the patient and family; as well as symptoms, such as spiritual distress and/or pain, guilt, resentment, despair, and hopelessness. SPIRITUAL, RELIGIOUS AND EXISTENTIAL ASPECTS OF CARE
• The IDT regularly explores spiritual and existential concerns and documents these spiritual themes in order to communicate them to the team. This exploration includes, but is not limited to: life review, assessment of hopes, values, and fears, meaning, purpose, beliefs about after-life, spiritual or religious practices, cultural norms, beliefs that influence understanding of illness, coping, guilt, forgiveness, and life completion tasks. Whenever possible, a standardized instrument is used.
• The IDT periodically reevaluates the impact of spiritual/existential interventions and documents patient and family preferences.
• The patient's spiritual resources of strength are supported and documented in the patient record.
• Spiritual/existential care needs, goals, and concerns identified by patients, family members, the palliative care team, or spiritual care professionals are addressed according to established protocols and documented in the interdisciplinary care plan, and emphasized during transitions of care, and/or in discharge plans. Support is offered for issues of life closure, as well as other spiritual issues, in a manner consistent with the patient's and the family's cultural, spiritual, and religious values.
• Referral to an appropriate community-based professional with specialized knowledge or skills in spiritual and existential issues (e.g. to a pastoral counselor or spiritual director) is made when desired by the patient and/or family. Spiritual care professionals are recognized as specialists who provide spiritual counseling.
5.3 Guideline: The PC service facilitates religious, spiritual, and cultural rituals or practices as desired by pt. & family, especially at and after the time of death. SPIRITUAL, RELIGIOUS AND EXISTENTIAL ASPECTS OF CARE
• Key Principle:
• Palliative professionals acknowledge their own spirituality as part of their professional role.
• Professional and institutional use of religious/spiritual symbols and language are sensitive to cultural and religious diversity.
• The patient and family are supported in their desires to display and use their own religious/spiritual and/or cultural symbols.
• Chaplaincy and other palliative care professionals facilitate contact with spiritual/religious communities, groups or individuals, as desired by the patient and/or family. Palliative care programs create procedures to facilitate patients' access to clergy, religious, spiritual and culturally-based leaders, and/or healers in their own religious, spiritual, or cultural traditions.
• Opportunities are provided to engage staff in self-care and self-reflection of their beliefs and values as they work with seriously ill and dying patients. Core expectations of the team include respect of spirituality and beliefs of all colleagues and the creation of a healing environment in the workplace.
• Non-chaplain palliative care providers obtain training in basic spiritual screening and spiritual care skills.
• The palliative care team ensures post-death follow up after the patient's death (e.g. phone calls, attendance at wake or funeral, or scheduled visit) to offer support, identify any additional needs that require community referral, and help the family during bereavement.
6.1 Guideline The palliative care program serves each patient, family and community in a culturally and linguistically appropriate manner. CULTURAL ASPECTS OF CARE
• Key principles: Culture is multidimensional. The word 'culture' implies the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values, and institutions of a racial, ethnic, religious, or social group"; Culture is far reaching. Cultural identification may include, but is not limited to, race, ethnicity, and national origin; migration background, degree of acculturation, and documentation status; socioeconomic class; age; gender, gender identity, and gender expression; sexual orientation; family status; spiritual, religious, and political belief or affiliation; physical, psychiatric, and cognitive ability; and literacy, including health and financial literacy.
• During the assessment process, the IDT elicits and documents the cultural identifications, strengths, concerns, and needs of the patient and family, with recognition that cultural identity and expression vary within families and communities.
• The plan of care addresses the patient's and family's cultural concerns and needs, recognizing and maximizing their cultural strengths.
• All palliative care staff consistently convey respect for the patient's and family's cultural perceptions, preferences, and practices regarding illness, disability, treatment, help seeking, disclosure, decision making, grief, death, dying, and family composition.
• Palliative care program staff communicate in a language and manner that the patient and family understand.
• Personnel tailor their communication to the patient's and family's level of literacy, health literacy, financial literacy, and numeracy.
• When patients and families do not speak or understand English, or feel more comfortable communicating in a language other than English, the palliative care program makes all reasonable efforts to use professional interpreter services, accessed either in person and/or by phone.
• When professional interpreter services are unavailable, other health care providers, preferably those trained in palliative care, may interpret for patients and families. Family members are not placed in the role of interpreter. However, in the absence of all other alternatives, family members may interpret in an emergency situation, if the patient and family agree to this arrangement.
• In addition to interpreter services, the palliative care program endeavors to provide written materials in each patient's and family's preferred language. When translated written materials are unavailable, the program utilizes professional interpreter services, as described above, to facilitate patient and family understanding of information provided by the program.
• Palliative care staff respect and accommodate dietary and ritual practices of patients and their families.
• Palliative care staff members identify community resources that serve various cultural groups and refer patients and families to such services, as appropriate.
6.2 Guideline: The palliative care program strives to enhance its cultural and linguistic competence. CULTURAL ASPECTS OF CARE
• Key Principles: Cultural competence refers to “the process by which individuals and systems respond respectfully and effectively to people of all cultures and languages in a manner that recognizes, affirms, and values the worth of individuals, families, and communities."
• The palliative care program values diversity, demonstrated by creating and sustaining a work environment that affirms multiculturalism. The recruitment, hiring, retention, and promotion practices of the palliative care program reflect the cultural and linguistic diversity of the community it serves.
• Palliative care staff members cultivate cultural self-awareness and recognize how their own cultural values, beliefs, biases, and practices inform their perceptions of patients, families, and colleagues. Staff members strive to prevent value conflicts from undermining their interactions with patients, families, and colleagues.
• To reduce health disparities within and among the communities it serves, the palliative care program provides education to help staff members increase their cross-cultural knowledge and skills.
• The palliative care program regularly evaluates and, if needed, modifies its services, policies, and procedures to maximize its cultural and linguistic accessibility and responsiveness to a multicultural population. Input from patients, families, and community stakeholders is elicited and integrated into this process.
7.1 Guideline: The interdisciplinary team identifies, communicates, and manages the signs and symptoms of patients at the end of life to meet the physical, psychosocial, spiritual, social, and cultural needs of patients and families. CARE OF THE PATIENT AT THE END OF LIFE
• Key Principles: Care of the patient at the end of life is time and detail intensive, requiring expert clinical, social, and spiritual attention to the process as it evolves. Care of the patient is divided into three phases; pre-death, peri-death, and post-death; The IDT recognizes the need for high acuity and high intensity care during the dying process.
• The IDT routinely elicits and honestly addresses concerns, hopes, fears, and expectations about the dying process in a developmentally appropriate manner, with respect for the social and cultural context of the family (See Domain 6: Cultural Aspects of Care).
• In collaboration with the patient and family, the IDT provides care with respect for patient and family values, preferences, beliefs, culture, and religion.
• The IDT acknowledges the patient's needs at the end of life and educates the family and other care providers about what to expect in terms of the death. As death approaches, they communicate signs and symptoms of imminent death, in culturally and developmentally appropriate language, with attention to population specific issues and age appropriateness.
7.2 Guideline The interdisciplinary team assesses and, in collaboration with the patient and family, develops, documents, and implements a care plan to address preventative and immediate treatment of actual or potential symptoms, patient and family preferences for site of care, attendance of family and/or community members at the bedside, and desire for other treatments and procedures. CARE OF THE PATIENT AT THE END OF LIFE
• The IDT assesses the patient for symptoms and proactively prepares family and other caregivers on the recognition and management of potential symptoms and concerns.
• With the patient and family, a plan is developed to meet their unique needs during the dying process as well as the needs of family immediately following the patient's death. Reassessment and revision of the plan occurs in a timely basis.
• Any inability to honor the patient's and family's expressed wishes for care immediately leading up to and following the patient's death is documented and communicated in the medical record that is accessible to other health care providers.
• For patients who have not accessed hospice services, care planning at this stage may include the introduction or reintroduction of a hospice referral, if such an option is congruent with the patient's and family's goals and preferences.
• Before the patient's death, sensitive communication occurs, as appropriate, about autopsy, organ and tissue donation, and anatomical gifts, adhering to institutional and regional policies.
7.3 Guideline: Respectful post-death care is delivered in a respectful manner that honors the patient and family culture and religious practices. CARE OF THE PATIENT AT THE END OF LIFE
• Key principle:
• In post-death, the focus of care includes respectful care of the body and support of the family.
• The interdisciplinary team assesses and documents cultural and religious practices particular to the post-death period, and delivers care honoring those practices, in accordance with institutional practice, local laws, and state regulations.
7.4 Guideline: An immediate bereavement plan is activated post-death. CARE OF THE PATIENT AT THE END OF LIFE
• The IDT formulates and activates a post-death bereavement plan based on a social, cultural, and spiritual grief assessment.
• A health care team member is assigned to support the family in the post-death period and assist with religious practices, funeral arrangements, and burial planning.
8.1 Guideline: The patient or surrogate's goals, preferences, and choices are respected within the limits of applicable state and federal law, current accepted standards of medical care, and professional standards of practice. Person-centered goals, preferences, and choices form the basis for the plan of care. ETHICAL AND LEGAL ASPECTS OF CARE
• The IDT includes professionals with knowledge and skill in ethical, legal, and regulatory aspects of medical decision-making.
• To assist in understanding patient and family decision-making, the patient or surrogate's expressed values, care preferences, religious beliefs, and cultural considerations are sensitively elicited, in collaboration with the family. Confirmation of these values, preferences, and considerations, with particular attention to change in health care status or transitions of care, is routinely reviewed and documented.
• The IDT discusses achievable goals for care in the context of patient values and preferences and educates the patient and family about advance care planning documents to promote communication and understanding of the patient's preferences for care across the care continuum. These documents may include, but are not limited to, designation of a surrogate health care decision maker (except for minors), inpatient and out of hospital do-not-resuscitate orders, and advance directives or living wills.
• Palliative care team members assist in the completion of these documents.
• All expressed wishes, preferences, values, goals, plan of care, surrogate decision makers and advance care plans are routinely documented, including the completion of clinical orders such as inpatient resuscitation status, out of hospital do not resuscitate orders, and health care surrogate declaration documents for adult patients. These care plans are accurately communicated when patients transition from one care setting to another.
• To determine decision making capacity, the ability of the patient and family to secure and accept needed care and to cope with the illness and its consequences is assessed. The adult patient with decisional capacity determines the level of involvement of the family in decision making and communication about the care plan. Patients with disabilities are assumed to have decision making capacity unless determined otherwise.
• Failure to honor the patient's or surrogate's preferences is documented and addressed by the team, and accessible to other health care providers
• In the care of pediatric patients with serious or life threatening illness, the child's views and preferences for medical care, including assent for treatment (when developmentally appropriate), is documented and given appropriate weight in decision-making. When the child's wishes differ from those of the adult decision maker, appropriate professional staff members are available to assist the child as well as the family.
• The team advocates for the observance of previously expressed wishes of the patient or surrogate in clinical situations. For patients who are unable to communicate and have not previously expressed their values, preferences, or beliefs, the palliative care team members seek to determine the presence of advance directives, evidence of previously expressed wishes, values and preferences, and designated surrogate decision makers.
• Assistance and guidance is provided to surrogate decision makers about the legal and ethical basis for surrogate decision making, including honoring the patient's known preferences, substituted judgment, and best-interest criteria.
• Patients and families are routinely encouraged to seek professional advice on creating or updating legal and financial documents such as property wills, guardianship agreements, and custody documents.
8.2 Guideline: The PC program identifies, acknowledges, and addresses the complex ethical issues arising in the care of people with serious or life-threatening illness. ETHICAL AND LEGAL ASPECTS OF CARE
• The palliative care team aims to prevent, identify, and resolve ethical dilemmas common to the provision of palliative care such as withholding or withdrawing treatments, instituting Do Not Resuscitate (DNR) orders, and the use of sedation in palliative care.
• All interdisciplinary team members have education in the fundamental ethical principles guiding the provision of palliative care.
• Ethical concerns commonly encountered in palliative care are identified, recognized, and addressed to prevent or resolve these concerns, using the ethical principles of beneficence, respect for individuals and self-determination, justice and non-maleficence, with attention to avoidance of conflicts of interest.
• Ethical clinical issues are documented and appropriate referrals are made to ethics consultants or a committee for case consultation and assistance in conflict resolution.
• Ethics committees are consulted in the appropriate manner to guide policy development, assist in clinical care, and provide staff education in common palliative care situations including, but not limited to: a patient's right to decline treatments of any kind; use of high dose medications; withdrawal of technology (e.g. ventilators, dialysis, antibiotics); palliative sedation, futile care, and cessation of hydration and artificial and oral nutrition.
8.3 Guideline: The provision of PC occurs in accordance with professional, state and federal laws, regulations and current accepted standards of care. ETHICAL AND LEGAL ASPECTS OF CARE
• Key principle: Access to legal and regulatory experts is imperative to provide care in accordance with legal and regulatory aspects of palliative care.
• The palliative care program is knowledgeable about legal and regulatory aspects of palliative care.
• Palliative care practice is modeled on and consistent with existing professional codes of ethics, scopes of practice, and standards of care for all relevant disciplines.
• Palliative care providers are knowledgeable about federal and state statutes, regulations, and laws regarding: disclosure of medical records and health information; medical decision making; advance care planning and directives; the roles and responsibilities of surrogate decision-makers; appropriate prescribing of controlled substances; death pronouncement and certification processes; autopsy requests, organ and anatomical donation; and health care documentation.
• Adherence to legal and regulatory requirements is expected for disclosure, decision making capacity assessment, confidentiality, informed consent, as well as assent and permission for people not of legal age to consent.
• The palliative care program establishes and implements policies outlining staff responsibility in regards to state and federal legal and regulatory requirements regarding patient and family care issues such as abuse, neglect, suicidal ideation, and potential harm to others.
• The palliative care staff recognizes the role of cultural variation in the application of professional obligations, including information on diagnosis, disclosure, decisional authority, care, acceptance of and decisions to forgo treatments (see Domain 6: Cultural Considerations). Attention is paid to the rights of children and adolescents in decision making.
• Legal counsel is accessible to palliative care providers particularly in common palliative care situations including but not limited to: determination of decision-making capacity, use of high dose analgesic or anxiolytic medications, withdrawal of technology (e.g. ventilators, dialysis), palliative sedation, use of "futile" care, and cessation of artificial and oral nutrition and hydration.

The PC Measure Menu: Overview and Instructions

Developed by PC-Insights (Kathleen Kerr, Brian Cassel and Lewis Broome, Principles) with support from the California HealthCare Foundation


Overview

The Palliative Care (PC) Measure Menu is a web-based tool that allows users to consider a wide range of metrics that speak to the quality of and contributions made by a specialty PC service, as well as the quality of palliative and end-of-life care (EOL) delivered to a population of patients.

By using the Menu’s filter features, users can leverage the descriptive information provided about each metric to select for specific types of metrics, care settings, data requirements and so on, and to exclude from consideration metrics that would not be appropriate or feasible. This allows users to narrow the field of candidate metrics, making the process of selecting metrics much more manageable. Users can consider sequentially metrics pertaining to specific domains of palliative care, for example beginning with metrics that address general structures and processes of care, then moving to metrics that speak to physical aspects of care, and so on. This iterative process will allow for development of a balanced measurement portfolio that only includes metrics that are feasible and meaningful to a particular program or organization.


Metric Sources

The Menu includes a few hundred metrics derived from 19 sources. Many of the metrics (and the source measure sets) were identified in two recent systematic reviews:

Kamal AH, Gradison M, Maguire JM, Taylor D, Abernethy AP. Quality measures for palliative care in patients with cancer: a systematic review. J Oncol Pract. 2014 Jul;10(4):281-7.

De Roo ML, Leemans K, Claessen SJ, Cohen J, Pasman HR, Deliens L, Francke AL; EURO IMPACT. Quality indicators for palliative care: update of a systematic review. J Pain Symptom Manage. 2013 Oct;46(4):556-72).

The Menu includes metrics that address the National Quality Forum (NQF) National Framework and Preferred Practices for Palliative and Hospice Care Quality, pertinent metrics that are used or endorsed by regulatory or accreditation groups such as The Joint Commission and the National Committee for Quality Assurance, and several that are used in Dartmouth Atlas of Healthcare, an important national benchmarking database. The Menu also includes metrics that are sourced as “Common use”; these are metrics that the Menu authors know to be in use by PC programs, often for the purpose of describing operational activities, like the number of patients served or the timing of care delivery.

The Sources page, found in the Menu’s Resources section, includes a description of each source measure set, a few notes about how the metrics were developed and their intended use, the original care setting the metrics were used in (hospice, hospital, etc.), pertinent references from the peer- reviewed literature, and links to source documents or program pages, if available.


Using the Filters

Setting / Group: Use the tabs at the top of the Menu to specify the setting/group for which you are selecting metrics:

Community-based PC: use this tab to select metrics for a specialty community-based service, such as PC clinics, home-based PC services, and distance/telemedicine PC programs

Population of Patients: use this tab to select metrics that would be useful in evaluating the quality of palliative or EOL care delivered to an entire population (e.g., all patients cared for by a health system, all health plan members, all patients cared for by a medical group)

Inpatient PC service: use this tab to select metrics for a specialty inpatient PC service

Hospital or hospital unit: use this tab to select metrics that would be useful in evaluating palliative or EOL care delivered to all hospitalized patients, or all patients using a specific hospital unit

Required data: Use the Required Data fields to narrow down the list of possible metrics that your program might use, based on the kind of data that you currently have access to or would be willing to generate. For example, if your program does not have access to data describing date of death (regardless of location of death) you would want to uncheck the “Date of Death” box, since you would not be able to use any metrics that require that variable (for example, proportion of patients who receive chemotherapy within 14 days of death.)

Date of death: Date of death, regardless of location of death.

Chart data: Includes information about which services were provided by which disciplines, and when; diagnostic, demographic or clinical data; or information about goals of care, patient- family preferences or surrogate identification. Some “Chart data” can be gathered from claims or administrative records; for example, you can use ICD-9/10 diagnosis or procedure codes to determine which patients received chemotherapy. Organizations with nimble electronic health records (EHRs) may be able to use those systems to extract information about some care processes (e.g., that a spiritual assessment occurred) or clinical data (pain and other symptom scores). For other groups, gathering such data would require manual review of individual records. The specific kind of “Chart data” that is needed for a given metric and the ease with which those data can be gathered (electronic vs manual means) will have huge feasibility implications. Think long and hard before adopting a metric that requires manual chart review. In most cases, such metrics should be avoided, or only used on a random sample of cases, periodically. Many palliative care programs record detailed information about their care processes and clinical information about their patients – data that are either entered into a standalone database or integrated into an EHR. In such cases, metrics that rely on a lot of “Chart data” can be used to evaluate care delivered by the PC team, even if it would not be feasible to use those same metrics to evaluate care delivered to all seriously ill patients that had contact with the larger enterprise/organization.

Use of Hospital or Emergency Room: Data describing hospital use or use of a specific unit in the hospital, or visits to an emergency room. Many community-based PC providers will not have access to such information. Such programs might have an easy time gathering detailed data about what their providers do for patients, but they won’t necessarily have access to detailed (or any) data describing their patients’ other contacts with the health system.

Use of Hospice: Data describing hospice use, including date of enrollment and duration of service. Many health systems only know that a patient has elected to use hospice when “Hospice” is the designated discharge disposition for an acute care hospital stay. In other cases, good EHR’s are being used to document hospice enrollment that is recorded in clinic notes.

Care Delivered in Outpatient Settings: Data describing services provided or information gathered in outpatient settings, such as clinics.

Survey Responses: Including surveys administered to patients, families or referring providers.


Metric Type: Structure metrics (what’s in place), Process metrics (details of service provision), Outcome metrics (impact of care delivery)

Metric Focus: For structure and process metrics, Metric Focus specifies which of the eight National Consensus Project (NCP) Domains the metric applies to, or if it is an “Operational” process metric (commonly used to describe volume and other characteristics of service delivery not associated with one of the eight domains.) For outcome metrics, Metric Focus specifies outcome type: Clinical/Patient- reported, Social (family, caregiver or provider), and Utilization/Fiscal.

NQF Endorsement: Indicates if a metric has been endorsed by the National Quality Forum (NQF). Metrics that are markedly similar to or derived from NQF endorsed metrics are flagged as “Adapted.”

MWM recommended: Noted “Yes” if the metric was one of the 9 recommended by the American Academy of Hospice and Palliative Medicine/Hospice and Palliative Nurses Association’s Measuring What Matters (MWM) initiative (http://aahpm.org/quality/measuring-what-matters). Metrics that are markedly similar to or derived from MWM Recommended metrics are flagged as “Variant.”

Metric Source: Specifies the entity that developed, tested, recommended or is currently using the metric. Details about Sources are available in the Sources page, found in the Menu’s Resources section.


Reviewing Results

Click on the “Show Results” button to view the metrics that met the criteria you specified in the Filter section. Information about the Focus/Domain, Metric Type, Source, and the text of the metric or quality indicator will be displayed, along with the following information:


Original population: Short description of the population/setting that was used when the metric was originally developed (PC patients, cancer patients, patients in an Intensive Care Unit, etc.) Note that in many cases metrics are appropriate for more than just the “original” population. Some metrics that were originally developed to assess care delivered to an entire population work perfectly well for specialty PC services; some metrics that were developed for specialty PC services can be used to assess quality of care delivered to an entire population. Similarly, some metrics that were originally developed for a specific disease group (like cancer) are appropriate for other populations. Details about Original Populations are available in the Sources page, found in the Menu’s Resources section.

NCP reference: Each Structure and Process metric is linked to a specific guideline (or guideline criterion) described in the NCP Clinical Practice Guidelines for Quality Palliative Care, 3rd edition (available at: http://www.nationalconsensusproject.org/Guidelines_Download2.aspx ). The full text of the 27 NCP guidelines and all supporting criteria are available in the NCP Guidelines page, found in the Menu’s Resources section.


Exporting Candidate Metrics

Use the “Add” buttons displayed in each row of the Results page to add metrics that your program might use to the My Metrics cart. A spreadsheet listing cart contents can be exported to your computer.


Learning More about PC Metrics

Want to learn more about measuring in palliative care? The California State University Institute for Palliative Care offers a self-paced, online course, Metrics and Measurement for Palliative Care (http://csupalliativecare.org/organizations/roadmap/metrics-measurements/) that covers a number of useful topics, including:

  • How to apply well-known measurement frameworks in healthcare to palliative care specifically;
  • The five crucial steps for choosing measures wisely;
  • How to use the PC Measure Menu to simplify and expedite the process of identifying measures and selecting a balanced, feasible portfolio of metrics;
  • Tips for being successful and avoiding mistakes that are commonly made in this area.


Questions or Comments?

Feel free to contact the developers if you have questions, if the tool gives you any trouble, or if you have a metric that you think might be a nice addition to the Menu.

Kathleen Kerr (concept and content): kathleen@pc-insights.com

Brian Cassel (concept and content): brian@pc-insights.com

Lewis Broome (web tool): lewis@pc-insights.com