Measure Information Form

Measure Set: Palliative Care(PAL)

Set Measure ID: PAL-03

Performance Measure Name: Dyspnea Screening

Description: Proportion of palliative care patients who were screened for dyspnea during the palliative care initial encounter.

Rationale: As described from the University of Chapel Hill PEACE Measure Set project, dyspnea is prevalent and undertreated for many populations of seriously ill patients, including those patients nearing the end of life. Screening for dyspnea is necessary to determine its presence and severity, and forms the basis for treatment decision-making. Unlike pain, structured clinical assessment of the symptom is less well-defined, yet similar to pain, effective treatment is available to alleviate symptom distress. Prevalence of dyspnea in advanced cancer ranges from 50-70%. Among COPD patients with advanced illness enrolled in the SUPPORT Study, dyspnea which was moderate to severe at least half of the time was present for at least 65% of patients throughout the 6 months preceding death. Effective treatment for dyspnea is available, but not consistently administered. Evidence-based treatments include pharmacologic interventions such as opioids and inhaled bronchodilators, and non-pharmacologic interventions including oxygen for hypoxic patients, pulmonary rehabilitation and exercise in COPD, and drainage of pleural effusion. (PEACE, 2015)

National Consensus Project for Quality Palliative Care (2013) guidelines recommend that the interdisciplinary team assesses and manages pain in a safe and timely manner to a level acceptable to the patient or surrogate and that symptom assessment, treatment, side effect and treatment outcome information should be recorded in the medical record

Type of Measure: Process

Improvement Noted As: Increase in the rate

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal or other ICD-10CM/PCS diagnosis and procedure codes, which require retrospective data entry.

Data Accuracy: Variation may exist in the assignment of ICD-10CM/PCS codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. Please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications Section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

• Bausewin C, Booth S, Gysels M et al. Non-pharmacologic interventions for breathlessness in advanced stages of malignant and nonmalignant diseases. Cochrane Database Syst Rev 2009. Apr 16; 2:CD005623.
• Ben-Aharon I, Gafter-Gvili A, Paul M et al. Interventions for alleviating cancer-related dyspnea: a systematic review. J Clin Oncol 2008; 26:2396-2404.
• CMS Hospice Item Set, http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-Item-Set-HIS.html
• Currow DC, Ward AM, Abernethy AP. Advances in the pharmacologic management of breathlessness. Current Opin Supp Pall Care 2009; 3:103-106.
• Dy SM, Lorenz KA, Naeim A et al. Evidence-based recommendations for cancer fatigue, anorexia, depression and dyspnea. J Clin Onc 2008; 26:3886-3895.
• Lorenz KA, Lynn J, Dy SM et al. Evidence for improving palliative care at the end of life: a systematic review. Ann Intern Med 2008; 148:147-159.
• Luce JM, Luce JA. Management of dyspnea in patients with far-advanced lung disease. JAMA 2001; 285:1331-1337.
• Measuring What Matters, http://aahpm.org/quality/measuring-what-matters
• National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. 3rd ed. Pittsburgh, PA: Author; 2013. http://www.nationalconsensusproject.org/NCP_Clinical_Practice_Guidelines_3rd_Edition.pdf
• PEACE Hospice and Palliative Care Quality Measures, http://www.med.unc.edu/pcare/resources/PEACE-Quality-Measures
• Roberts DK, Thorne SE, Pearson C. Cancer Nurs 1993; 16:310-320.

Original Performance Measure Source / Developer:
American Academy of Hospice and Palliative Care (AAHPM) and Hospice and Palliative Nurses Association (HPNA) Measuring What Matters Project Top Ten Measures That Matter List
CMS Hospice Item Set
PEACE Hospice and Palliative Care Quality Measures Set

Measure Algorithm: