Dale Lupu, PhD

AAHPM VP for Professional Development


Posts by Dale Lupu, PhD

Innovations in quality improvement: help spread the word!

JPSM has announced a new call for brief reports explaining the results of quality improvement initiatives in palliative care. JPSM associate editor David Casarett and members of the AAHPM Quality Task Force were puzzled by the dearth of good information about what quality improvement innovations programs are finding successful. They realized that there aren’t many good venues for sharing the results of quality improvement initiatives, since the journals typically focus on publication of more traditional research. Thus, the idea was born for a special JPSM series on quality improvement, which will review submissions against criteria appropriate to quality improvement, not research. This series is aimed at sharing quality improvement initiatives in hospice and palliative care so that we begin to build a shared body of knowledge about what works (or doesn’t) to improve hospice and palliative care.

If your program has a quality improvement innovation of which you are proud, please take the next step and share it with your colleagues via the JPSM series. Submissions are due April 15, 2011. More information about the call.

Academy Voices Vital Role of Palliative and Hospice Care in Improving Quality of Health Care

Many health care initiatives launched by the Affordable Care Act focus on improving the quality of health care. The Academy and its members have been participating in these efforts, trying to bring wider visibility to the role that palliative care and hospice care can play in improving the quality of health care for patients with serious, advanced illness. Here’s a brief recap of some of the recent activity:

  • The Palliative Care and End-of-life Care workgroup of the National Priority Partners, (convened by the National Quality Forum), held an all day workshop on November 2 to come up with priorities to promote the diffusion of palliative care throughout the health care system. Numerous AAHPM members either presented or participated, including Sean Morrison, Sarah Friebert, Javier Kane, Karl Lorenz, Christine Ritchie, and Joan Teno. Diane Meier presented the opening overview, examining the current state of palliative and hospice care services and opportunities to improve access and close performance gaps. The speakers’ slides are posted on the NPP website.
  • AAHPM submitted comments to the Secretary of HHS on the National Health Care Quality Strategy and Plan. AAHPM’s public policy advisors see this plan as a critical document that will likely guide how federal energy and resources are spent over the next several years. AAHPM’s comments (which other Hospice and Palliative Care Coalition member organizations also submitted) made two main recommendations:
    • Add focus on patient-centered care guided by palliative care principles to measurement and accountability for all providers serving seriously ill patients.
    • Assure that specialty level palliative care and hospice services are broadly available and of demonstrably high quality.

Specific actions needed to achieve the above goals were also specified.

  • AAHPM also submitted comments (as part of the Hospice and Palliative Care Coalition) on the National Quality Forum measure gap agenda. Incredulously, the committee that ranked priorities for measures needed over the next few years ranked palliative care LAST. It received ZERO votes! The Coalition said in its comments: “the Coalition urges the NQF to recognize the urgency of making palliative care measures a high priority on the national measure development agenda.”

AAHPM’s Quality Task Force, chaired by Sydney Dy, would appreciate hearing from you about how we are articulating the need for quality palliative and hospice care. Please leave a comment and let us know whether you think we are succeeding in making the case.


Heads up!! Calling all measure geeks!! Save the date: NQF call for measures planned for November 2010

This post was co-authored by Dale Lupu, PhD and Sydney Dy, MD

The National Quality Forum (NQF) is planning to issue a call for measures relevant to hospice and palliative care some time late in 2010, probably November. This is a critical opportunity to advance quality measurement for our field. (Hopefully, quality improvement follows on the heels of measurement.) Any of you who have submitted measures to NQF in the past know that quite a bit of effort goes into filling out the measure submission form, so we wanted to give you some advance notice as you think about the workload for yourself and your team going into the fall. Once NQF issues the call for measures, you will have 30 days to submit the forms. Here are links to general information on the NQF measure submission and endorsement process:

Every measure endorsed by NQF has to have a measure steward. The measure steward is responsible for making the necessary updates to the measure, and for informing NQF about any changes that are made to the measure on an annual basis. The measure steward is also responsible for providing the required measure information for the measure maintenance process that occurs approximately every three years.

If your organization has developed quality measures that you are finding useful in guiding quality improvement within hospice and palliative care, please consider submitting the measure(s) to NQF in the fall. It is very important that NQF receive a strong and robust set of measures to consider for endorsement. NQF endorsed measures form the backbone of pay for performance and value-based purchasing efforts that will likely impact more and more on hospice and palliative care in the coming years. The field needs a strong set of endorsed measures to move quality improvement efforts forward.

For those of you who fit the category of “measure user” more than “measure developer” – take heart. When it is finished, the results of this NQF project will be an important resource for you. A clear set of NQF endorsed measures in palliative and hospice care will make it easier for you to select and promote measures in your own setting. Begin laying the groundwork now for eventual implementation by spreading the word to the quality gurus in your organization that NQF endorsed palliative care measures are on the way for 2011.

The unsung work of AAHPM committees

Blog #2 from AAHPM consultant Dale Lupu

So there were 26 AAHPM committees, task forces, and Strategic Coordinating Committees (SCC) working in 2009. Because so much of the work is “behind the scenes,” it may be mysterious to many Academy members. I’m going to try to pull back the curtain just a bit to give you a glimpse.

You probably can envision the work of the committee charged with developing the program for the Annual Assembly. Like other committees, this group works both at a big picture level and a level that is “in the weeds.” At the weeds level, they have to decide how many sessions and select those sessions (with apologies to the many wonderful submissions that just couldn’t fit into the program). At the big picture level they map the big learning goals for the conference: what are the learning gaps for the field? What do people need in their different work setting (hospices big and small, hospital based palliative care, long-term care, rural, pediatric, etc.). What do different experience levels need? This year that big picture thinking led to a decision to integrate more pediatric content into the program and to conduct our first-ever forum for medical and nursing students.

But what about committees like Business Practices and Workforce? What do they do? Let me give you just two examples. In the Workforce area, the Board charged the Workforce Task Force with monitoring workforce trends and coming up with a strategy to enhance workforce capacity. This is a big charge, and the task force initially took some time to study and educate themselves about the issues. Last year the task force met for a half day with a national expert on physician workforce issues (Ed Salsberg of the AAMC). This helped us understand how the physician workforce issues in HPM relate to the overall shortage of primary care physicians and the looming shortages in certain specialties such as oncology. When we went around the table, almost all participants reported positions staying open for a year or more, despite intensive recruitment. Many programs were giving up on recruiting from the outside and were turning to a “grow your own” strategy. The task force decided that an important first step was to describe just how bad the workforce shortage really was. The task force developed a Workforce Trends paper – which was approved by the Board yesterday. (Look for the paper to come out in JPSM some time this summer. It shows we need between 4,400 and 10,800 FTE’s in the field, but currently have only 1,700 to 3,300 FTE’s in practice.) Of course, knowing how big the problem is only the beginning. Now we need to develop a range of solutions to this big problem.

Now turning to the Business Practices Task Force. They started with a member needs assessment. The survey results spoke loudly and clearly. Members are hungry for salary and compensation information. The committee considered how to get good information to fill that need and recommended to the board that AAHPM invest in a professional compensation survey to be conducted by an outside firm with deep experience in salary survey and reporting. The board approved that imitative, RFP’s were sent out, proposals were vetted, and a vendor (Mercer) was selected. The committee is now working with Mercer to design a survey tool that will be simple to fill out, yet capture the complexity and diversity of compensation in our field. Look for the compensation survey in your inbox this spring.

That’s just a glimpse of the work that went into two projects this year. There were many more (the Business Meeting gave an overview of all of the biggies.) Meanwhile – I need to run to two more committee meetings. Wish I can spend more time in sessions. Maybe next year.

Three Conferences in One

A view from AAHPM consultant – Dale Lupu

There are really three conferences going on here at the AAHPM/HNPA annual assembly. I think most of you can readily identify two of them: the formal program as laid out in the program book, and the informal networking that occurs in the halls, restaurants, and standing in line to buy books. My own experience, and I’m sure many of you share this, is that the formal program is only the start of the learning. It’s those smaller hall and restaurant conversations with a few colleagues (both old friends and those just met) where many memorable pearls are shared. And where the feeling of support – “you mean I’m not the only one experiencing this?” – is stoked.

But this year, I haven’t had time to delve as deeply as I would like into either of those two conferences, because I am attending a third. This third conference involves about 200+ Academy members who have been working all year on the 26 committees that have been charged with advancing the five major goals of the Academy’s strategic plan. The work that has already been accomplished by these committees is inspiring. That’s good, because we will need the inspiration to tackle the work still to be done.

Committee members conduct their work throughout the year via conference call and email. The annual assembly gives committee and task force members an opportunity to get into the same room, meet each other, reflect together, brainstorm, plan for the next year. Yesterday all of the SIG committee chairs gathered – the first time they have all been a room together (as SIG chairs). Today, I’ll be staffing the Academic Task Force chaired by Christine Ritchie, the Business Practices Task Force co-chaired by Chuck Wellman and Parag Bharadwaj, and the quality & Practice Standards Task Force chaired by Sydney Dy. Other committee chairs and members with their assigned staff person will also be meeting. Feel free to stop any of us and ask us to tell you about what we’re working on.

If you are interested in serving on a committee, visit the AAHPM page “membership/getting involved.”