Measuring the Quality of Hospice Care

Hospice care is a set of services that allow patients in the final phase of life to spend their last days at home or a home-like setting rather than in a hospital. It is for patients who have decided that they would rather have comfort care while they remain alive than curative care that may well be “futile.” Hospice care is highly related to palliative care, i.e., care intended to relieve symptoms such as pain, nausea, shortness of breath, and difficulty swallowing. A primary caregiver (typically a member of the family) needs to be available around the clock to provide for the patient’s basic needs for care, including support in activities of daily living.

Where Hospice Care Is Delivered

Most hospice patients receive this care at home, but some inpatient hospice facilities exist. In addition, some nursing homes are providing hospice care for patients for whom a nursing home has become their actual home.

For more information on hospice care, visit the Web site of the National Hospice and Palliative Care Organization at http://www.nhpco.org.

Coverage of Hospice Services

In the United States, hospice care is covered by a specific Medicare benefit that requires physicians to indicate they believe the patient has less than 6 months to live, and requires patients to forgo curative care for the illness that is expect to lead to their death, although they can still get treatment for other conditions. Medicaid and private insurance companies may include a similar benefit, but Medicare remains the primary payer for this type of care.

Consumer Use of Hospice Measures

Research with consumers makes it clear that:

• The public is ill-informed about hospice services.
• When presented with the nature of these services, they become interested in learning more and perhaps considering using hospice care if and when it is needed.^[1]

As a followup to this study, researchers and technical experts working with the American Hospice Foundation identified a set of measures suitable for reporting to consumers, almost all of which are already being collected by a significant percentage of hospice agencies. The team then created and tested a Model Report on Hospice Quality. To obtain a copy of the model report, contact the American Hospice Foundation at ahf@americanhospice.org.

Examples of Hospice Quality Measures for Consumers

Measures of hospice quality are relatively new.

Effectiveness Measures:

• Percentage of families who said:
  • The hospice staff worked well together as a team to provide care to the hospice patient.
  • The patient received the right amount of medication for his/her pain.
  • The patient received the right amount of help with his/her breathing.

Patient-Centeredness Measures:

• Percentage of families who said:
  • The patient was always treated with respect by the hospice team.
  • They received the right amount of emotional and spiritual support from the hospice staff.
  • The hospice team did something that was inconsistent with the care the patient wanted at the end of life.

Timeliness Measures:

• Percentage of families who said the hospice did an excellent job of responding to their needs on evenings and weekends.

Descriptive Measures: While not associated with any particular IOM domain, descriptive measures can convey the hospice agency’s capacity for providing high-quality care and service. Examples include:

• Average number of patients cared for daily.
• The ownership of the hospice agency.
• Whether the hospice has an arrangement with a hospital for inpatient beds for purposes of respite care.
• Whether physicians associated with the hospice are certified by the American Board of Hospice and Palliative Medicine.
• Whether nurses associated with the hospice are certified in the specialty of hospice and palliative care.
• Average number of visits to a patient per week by
  • Nurses.
  • All hospice staff.
  • Home health aides.
  • Social service staff.

^[1] Sofaer S, Hopper SS, Firminger K, et al. The potential impact of comparative hospice quality reports on the public: a focus group study Joint Commission Journal of Quality and Safety 2009 Aug;35(8):422-9.

Also in "Measures of Long-term Care Quality"

• Nursing Home Care
• Home Health Care
• Hospice Care