Quality Guidelines, Standards & Measures

• Program Standards and Guidelines
• Clinical Guidelines with Specific Palliative Care Content
• Indicator Sets and Measurement Tools
• More Measurement Sets and Tools
• Measures and Indicator Sets in Development

Program Standards & Guidelines

• The new Commission on Cancer standards now includes palliative care.
• National Consensus Project for Quality Palliative Care (2009). Clinical Practice Guidelines for Quality Palliative Care, Second Edition. http://www.nationalconsensusproject.org
• National Quality Forum (2006).A National Framework and Preferred Practices for Palliative and Hospice Care Quality.
• (P) Four articles in Journal of Palliative Medicine set out consensus recommendations for how to implement the NQF Framework and Preferred Practices. 
  • - Operational Features. November 2008
  • - Consultation Service Metrics, December 2008
  • - Inpatient Palliative Care Operational Metrics, January 2009
  • - Clinical Care and Customer Satisfaction Metrics, February 2010
• (H) Accreditation for hospice programs is offered by several organizations. The specific standards used by these accrediting organizations are only available as part of proprietary material. See each organization's website:
  • - TJC - The Joint Commission (formerly JCAHO). Hospices are accredited under the Home Health standards.
  • - CHAP - Community Health Accreditation Program.
  • (H) Medicare Conditions of Participation address Quality Assessment and Performance Improvement (QAPI) for hospice programs. The NHPCO website has links to the Conditions of Participation and to many additional resources for building a hospice QAPI program. 
  • (H) Pediatric Hospice. NHPCO has released standards of practice for pediatric palliative care.

Clinical Guidelines with Specific Palliative Care Content

- COMING SOON -
The Quality & Practice Standards Task Force plans to develop a resource list of clinical guidelines that are notable for their usefulness to hospice and palliative medicine practitioners in various settings. But we need your help to develop this resource list.

For an example of a similar list prepared by another medical society, visit the website of AAPMR. 

Indicator sets and Measurement tools

• Hospice AIM Toolkit A toolkit to use selected measures from the measure set developed in 2008 by the Carolinas Center for Medical Excellence's Prepare, Embrace, Attend, Communicate, Empower (PEACE) Project. The AIM toolkit was developed and tested by  the Island Peer Review Organization (IPRO), the New York State Quality Improvement Organization (QIO). 
• National Quality Forum Quality Positioning System (QPS)—a search tool to find NQF endorsed measures. Search on hospice and palliative care.
• NHPCO Peformance measures, including National Data Set (NDS), Family Evaluation of Hospice Care (FEHC), End Result Outcome Measures (EROM), and Family Evaluation of Bereavement Services (FEBS)
• PCPI(Physician Consortium for Performance Improvement) - run by the AMA. AAHPM participates.
  • PCPI measure list - scroll down to find the Palliative Care Measure set
• PQRI - (Physician Quality Reporting Initiative) The Medicare qualitymeasurement system for physicians and other clinicians.
  • 2011 PQRI measures(the following are those measures most likely appropriate to a palliative care practice:)
    #47 Advance Care Plan, 
    #81 End Stage Renal Disease (ESRD) Plan of Care for Inadequate Hemodialysis in ESRD Patients; 
    #82 End Stage Renal Disease (ESRD) Plan of Care for Inadequate Peritoneal Dialysis; 
    #130 Documentation and Verification of Current Medications in the Medical Record;
    #131 Pain Assessment Prior to Initiation of Patient Therapy and Follow-Up; 
    #134. Screening for Clinical Depression and Follow-Up Plan;
    #143. Oncology: Medical and Radiation – Pain Intensity
    #144. Oncology: Medical and Radiation – Plan of Care for Pain; 
    #154. Falls: Risk Assessment;
    #155. Falls: Plan of Care
    #186. Wound Care: Use of Compression System in Patients with Venous Ulcers
• TIME: Toolkit of Instruments to Measure End-of-Life Care
• VA Family Assessment of Treatment at End of Life Short form (FATE-S) see reference
• The final report of the National Quality Forum project "National Voluntary Consensus Standards for Palliative Care and End-of-Life Care" is available to download.
• The summary of palliative and end-of-life measures endorsed in 2012 by the National Quality Forum is available.

More measure sets & tools

A list of additional quality indicators with references is available as a download below.

Measures and Indicator sets in development

Investigators are invited to submit descriptions of measures that are currently in development for listing here.