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New palliative/end-of-life care measures for LTC

May 22, 2012
by Lisa Erbstoesser, RN
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New quality measures aimed to improve palliative and end-of-life services
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By 2030, there will be more than 72 million elderly Americans. With approximately 2.5 million people dying each year, and more than 40 percent of them under the care of a hospice agency, the need for quality palliative and hospice services is at an all-time high. It’s no wonder there is an increased focus on palliative and hospice care by the public and private sectors to ensure that high-quality end-of-life care is available to our aging population.

Palliative care programs offer symptom management and support to a person throughout a serious illness and can be used along with curative treatment. Hospice is a Medicare benefit that provides care for patients who are not expected to live beyond six months and who are not seeking aggressive curative treatment. It is the standard for compassionate, person-centered care and uses a multidisciplinary approach to deliver end-of-life care, encompassing symptom management and psychosocial, spiritual and bereavement services. Both programs honor personal preferences, which significantly improve quality of life and satisfaction with care.

In 2010, Section 3004 of the Patient Protection and Affordable Care Act directed that the Department of Health and Human Services establish a Hospice Quality-Reporting Program and publish nationally endorsed palliative and end-of-life quality measures. These measures require healthcare professionals to actively collect and measure data as it relates to the patient experience. 

NEW REPORTING DEADLINES

The first measure that will be required to be reported is the Structural/Quality Assessment Performance Improvement (QAPI), which ensures a hospice agency is participating in a QAPI program that includes at least three quality indicators related to patient care. Patient care-related indicators address such things as management of symptoms, patient safety and how personal preferences are honored.

The National Quality Forum (NQF) Measure #0209, also known as the “comfortable dying measure,” reflects the number of patients that report being in pain upon admittance and who report that pain is brought under control within 48 hours. This measure is designed to monitor and improve one of the most critical components of hospice service—pain management at the onset of care. Until now, the use and reporting of the two measures has been strictly voluntary, but for the data collected during the last quarter of 2012 reporting will be mandatory. Data submission deadlines are in the early part of 2013 and are required for hospice agencies to receive 2014 payment updates.

NEW QUALITY MEASURES

This past February, the NQF endorsed 12 additional quality measures concerning palliative and end-of-life care, with further mandatory reporting being considered by the Centers for Medicare & Medicaid Services. The newly endorsed measures address some of the core principles of hospice care. NQF measures #1634 and #1637 focus on screening and assessment of pain within the first 24 hours of care. NQF measure #1638 and #1639 address monitoring and treatment of dyspnea, and measure #1617 would track the percentage of adults given an opioid that are put on a bowel regimen. Most hospice agencies provide excellent symptom management, but for those that don’t, the new measures will play a role in shining a light on significant deficiencies.

Other aspects of hospice care that the new measures address are related to patient preferences. NQF measure #1641 would require reporting of the percentage of patients with chart documentation regarding life-sustaining treatment preferences, such as DNR status. Hospice is a holistic way to care for someone at end-of-life, and NQF measure #1647 demonstrates this by monitoring the percentage of patients who have been offered spiritual or religious support.

Palliative program measures #1626 and #1628 address the documentation of care preferences in ICU and assessment of pain during outpatient visits. A complete list of the new palliative and end-of-life measures can be found at www.qualityforum.org.

WILL THESE MEASURES IMPROVE LTC?

All 14 measures are designed to improve the quality of service provided by a hospice agency or palliative program. Measuring and reporting quality data to the government in association with performance-based payment and eventual public reporting provides enough impetus for most agencies to concentrate on quality assessment and performance improvement. When palliative and end-of-life care programs improve, the service, support and expertise they offer in the LTC setting also will improve.

Approximately 18 percent of all hospice deaths occur in nursing homes. The goal of the new measures is to make agencies more accountable and responsive to patients and their families. The new measures are expected to advance long-term care by improving the general delivery of hospice services, which would equate to fewer emergency room visits and readmissions to acute care settings for hospice patients.

Most importantly, the end-of-life care that is received in care communities will be more satisfactory to patients and their families. Effective measurement tools are necessary to set the stage to better equip more hospices across the nation to efficiently handle all of the complex symptom management and psychosocial issues that are unique to end-of-life care in nursing homes. 

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