Measure Information Form

Measure Set: Palliative Care(PAL)

Set Measure ID: PAL-04

Performance Measure Name: Treatment Preferences and Goals of Care

Description: Proportion of palliative care patients with medical record documentation of treatment preferences and goals of care.

Rationale: Seriously ill and dying patients who are given the opportunity to express life-sustaining treatment preferences are more likely to receive care consistent with their values, and patient and family satisfaction outcomes improve. Patients and physicians alike hesitate to initiate discussions, while acknowledging their value and desirability. Use of the Treatment Preferences quality measure will improve attention to this important practice, in order to enhance patient autonomy, facilitate patient-centered decision-making, and communicate patient preferences via documentation to other treating providers. Poor communication about patient preferences has been identified as a major quality concern in palliative and end-of-life care since an early, comprehensive Institute of Medicine report.(Field et al., 1997; as cited by PEACE) The SUPPORT Study found marked discrepancies between patient report of treatment preferences and provider awareness of or use of these preferences to guide treatment.(1995; as cited by PEACE) Patients and families prioritize communication with providers and control over treatment choices when faced with serious or life-threatening illness.(Steinhauser et al., 2001; as cited by PEACE) However, physicians and other providers fail to open the door to these discussions at critical time points in illness progression.(Gysels et al., 2004; as cited by PEACE) A recent systematic review of communication research found a consistent discrepancy between the quality and content of communication providers believed they provided, and the quality and content of communication experienced by seriously ill patients and their families. (Hancock et al., 2007; as cited by PEACE)

The National Consensus Project for Quality Palliative Care (2013) guidelines recommend that patient or surrogate’s goals, preferences, and choices be respected and used as the basis for the plan of care within the limits of laws and standards of care. The palliative care interdisciplinary team discusses achievable goals with the patient and family using a patient-centered approach that includes the patient values and preferences and assists with advance care planning documents to communicate patient preferences across care settings.

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:

• CMS Hospice Item Set, http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-Item-Set-HIS.html
• Field MJ, Cassell CK eds. Approaching Death: Improving Care at the End of Life. Washington, DC: National Academy Press, 1997.
• Gysels M, Richardson A, Higginson I. Communication training for health professionals who care for patients with cancer: a systematic review of effectiveness. Support Care Cancer 2004; 12:692-700.
• Hancock K, Clayton JM, Parker SM et al. Discrepant perceptions of end-of-life communication: a systematic review. J Pain Symptom Manage 2007; 34: 190-200.
• Measuring What Matters, http://aahpm.org/quality/measuring-what-matters
• PEACE Hospice and Palliative Care Quality Measures, http://www.med.unc.edu/pcare/resources/PEACE-Quality-Measures
• Steinhauser KE, Christakis NA, Clipp EC et al. Preparing for the end of life: references of patients, families, physicians and other care providers. J Pain Symptom Manage 2001; 22:727-737.
• SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients: the Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatments (SUPPORT). JAMA 1995; 274:1591-1598.
• 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

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: