Quality

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.


Quality and competency: Invisible members of the palliative care team, the Medical Interpreter

We spend a lot of time speaking of physician, nursing, social work, pharmacist expertise in palliative care. We often see and support formal training for volunteers. (www.volunteertrainingonline.com/hospice; www.hospicevolunteertraining.webs.com) We teach the importance of culturally competent care and use of interpreter services to enhance communication with patients and families of other cultures and with limited English. Studies have shown the miscommunication that occurs when interpreters are not used in medical encounters.

At the European Association of Communication in Healthcare (EACH) conference in Verona Italy the opening keynote speaker, Phyllis Butow, a psychologist and professor of psycho-oncology and medical communication, presented research that caused me pause and concern. Her research, conducted in Australia, demonstrated that our assumptions about accuracy of language transmitted to patients/families when interpreters are used may be flawed – especially when interpreters lack training in giving bad news, end-of-life care, etc.

Her interviews with interpreters also revealed that professional interviewers define their role as cultural (as well as language) interpreters. In doing so, “cancer” sometimes was described as “mass” or “tumor” according to her presentation. Interpreters expressed similar cultural biases and fear of giving bad news as many other healthcare professionals.

  • How often does this happen in North America, as it seems to in Australia?
  • How much training do medical interpreters in the US, Canada, and other countries receive in delivering bad news, end-of-life care, death and dying?

Mandating the presence of a medical interpreter may not be enough when it comes to improving cross-cultural and inter-language communication in palliative care scenarios: we need to include medical interpreters in our definition of interdisciplinary teams, provide them training (not just teach physicians and advance practice nurses how to work with interpreters) in giving bad news.

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.