Quality Measurement in Palliative Care

Helene Starks, PhD MPH Director Metrics, Quality & Evaluation Core Cambia Palliative Care Center of Excellence Associate Professor Dept. of Bioethics & Humanities, School of Medicine www.uwpalliativecarecenter.com

High interest in PC QI

Value proposition Value =

Quality Cost

Arguments for Palliative Care  We improve quality  We reduce costs without compromising outcomes

How do we do it? • What’s in the “syringe”       

Interdisciplinary care teams Symptom management Expert communication & support Narrative-based goals of care & quality Continuity Coordination Family is integral part of unit of care

Palliative care landscape • Primary Palliative Care  Provided by all clinicians caring for patients with serious illness across the continuum of care

 Outpatient clinics and community-based services & institutions

• Specialty Palliative Care  Provided by palliative care specialists including MDs, RNs & ARNPs, PAs, SWs, spiritual care providers and others

 Inpatient & outpatient consultation services, homebased palliative care/transitions programs, hospice

Implications of diverse PC landscape Context: PC QI across the continuum of care

Types of care setting

Home

Types of care providers

QI, IT, Legal, Other Spiritual Org. Change Care Social Work Agents Pharmacists Nurses’ assistants Inpatient Home LTC (SNF, Outpatient PC PC PC Consult AFH) Health Service Nurses Specialty PC MDs ARNPs/ PAs Types of Primary PC

organizational stakeholders

Quality improvement cycles 1. What are we trying to accomplish? 2. How will we know that a change is an improvement? 3. What changes can we make that will result in an improvement?

Act

Plan

Study

Do

PDSA Cycle

PDSA & Performance Improvement Plan PDSA Performance Improvement (PI) plan Plan

• Objectives • Outcomes/measure specification

Do

• Data collection

Study • Results Act

• Reporting • Action steps

PC Stakeholders

5 Essential Steps for QI Cycles Identify Issue Specify Outcomes & Measures

Design Intervention

Engage Stakeholders

Define Population

Identify issue & engage stakeholders 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Utilization @ End of Life ED visits in last 30 days Inpatient in last 30 days ICU stay in last 30 days Hospital readmissions Chemo in last 14 days Circumstances of Death Died in hospital Died in hospital w/ ICU days Died after planned ICD deactivation Died w/ cancer & no hospice Died w/