The wide range of palliative care services available nationwide can present obstacles around consistent quality measurement. Calls are growing louder for a federally established set of standardized palliative guidelines.
Capturing real-time quality data is an important part of effectively managing patients’ symptoms and needs, according to Dr. Monisha Pujari, medical director of Georgia-based Longleaf Hospice & Palliative Care. But palliative care providers largely lack a standardized way of measuring quality, she stated.
Palliative providers are currently not recognizing their full potential of quality care delivery without stronger guidelines in place, Pujari said.
“Palliative has tremendous value in terms of quality for a patient,” Pujari told Palliative Care News. “But one of the key things that we’re missing on the palliative care side is capturing patient data in a way that shifts away from just the medical management. We can miss the forest through the trees if we focus on pure medical management and not the existential and other symptoms distressing a patient.”
Forces fueling quality measures
More health care providers across the continuum are leveraging palliative care as a way to improve overall patient and family experiences, said Yonah Klein, chief growth officer at Unity Hospice and Palliative Care. The hospice and palliative care provider’s quality initiatives include a focus on staff training, patient feedback and embracing new, evidence-based best practices in the field.
While palliative care models vary nationwide, common quality indicators have surfaced. These include pain and symptom relief, goal-concordant care delivery and cost-effectiveness, according to Klein. The quality trends are pushing more providers to develop methodologies that can evaluate patient and cost-saving data.
“Providers are defining quality in palliative care by focusing on outcomes that matter most to patients such as symptom relief, enhanced quality of life and better alignment of care with patient goals,” Klein told Palliative Care News in an email. “Additionally, patient and family satisfaction, as well as cost-effectiveness, are increasingly recognized as important indicators of high-quality palliative care.”
The diverse landscape of palliative care services that exists today presents both opportunities and challenges when it comes to defining quality, according to Keith Everett, CEO, ProCare Hospice in Nevada. Everett is also founder and principal of the consulting firm TruHue LLC. The variances of palliative programs allows for diversified, individualized care delivery, he stated. However, the lack of consistent measures leaves quality open to interpretation.
A lack of standardized palliative quality measures has hindered the ability for many programs to thrive, let alone take flight with new service lines, Everett indicated. Regulatory alignment and advocacy will play a large role in defining the future outlook of palliative care delivery, he stated.
“Although we lack a dedicated federally established reimbursement framework specific to palliative care quality measures, aligning our practices with existing regulatory and accreditation standards is critical,” Everett told Palliative Care News. “At the same time, advocacy for more tailored quality measures is necessary to further advance the field.
Weaving threads of palliative care quality
Certain commonalities have been gaining ground to pave the way for greater clarification and standardization, Everett said.
Data around timely access to care, advance care planning services, frequency of emergency department utilization and hospitalizations, pain level assessments and treatments can all serve as triggers for measuring palliative care quality, according to Everett.
Quality can be defined in various avenues such as data-driven examination of patient outcomes, value-based reimbursement care alignment, integration across other health specialties and through equitable access, he said.
Some of the challenges in capturing and measuring quality center around the interdisciplinary nature of these services, according to Pujari. Patient data must be gathered and synthesized across several areas of health care managing an individual’s care, she stated.
Future quality measures need to take into account the multitude of disciplines that could be collaborating on patient care. Any palliative quality regulations should consider an avenue to comprehensively collect and measure outcomes that go beyond medical or physical treatment, Pujari stated. Emotional, spiritual, psychosocial and practical needs are an equally significant part of quality, she added.
“The difficulty with palliative care is that there are a lot of cooks in the kitchen co-managing patients,” Pujari said. “We need to capture quite a bit more and be much more cognizant and consistent in admitting and managing a patient to palliative care. If [policymakers] started putting into place those kinds of tools that would further facilitate quality measures, patient onboarding guidelines, then we might recognize when patients have issues and have better continuity of care, management and overall recognition of what’s going on with the patient.”
Palliative care providers need stronger methodologies to demonstrate and measure quality, Everett said.
Technology innovations will be a large driver toward greater quality transparency and accountability, he indicated.
“Each palliative care provider is determining their own sort of definition, and how they define what quality looks like,” Everett said. “It’s defined by looking at a combination of both process and outcomes measures to ensure that palliative care patients are getting into care that they deserve at the time that they need it. You can absolutely have a combination of the measure and process pieces within triggers of a patient’s electronic medical record.”
TruHue has developed a palliative care patient survey that addresses clinical care, communication, access, psychosocial factors and overall satisfaction. The Tru Satisfaction©: Evaluating the Advanced Illness Experience will allow for honest patient and family feedback, he stated. The survey examines pain management and relief, anxiety management, shortness of breath and timeliness of services, among other patient measures.
The survey has a two-fold purpose of aiming to more narrowly define quality and identify patient barriers, according to Everett.
“This is another way to show how your quality is performing and how you’re serving palliative care patients,” he told Palliative Care News. “It’s the feedback that’s going to tell you what new quality measures to measure, what particular outcomes you may not be tracking and what the social determinants of health are that may be impacting your ability to provide a higher level of care. You identify what those barriers are to the patient.”
