Quality of palliative care for patients with advanced cancer in a community consortium.
Arif H Kamal, Ryan D Nipp, Janet H Bull, Charles S Stinson, Ashlei W Lowery, Jonathan M Nicolla, Amy P Abernethy
Author Information
Arif H Kamal: Duke Center for Learning Health Care, Duke University Medical Center, Durham, North Carolina, USA; Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina, USA; Center for Palliative Care, Duke University Medical Center, Durham, North Carolina, USA; Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA. Electronic address: Arif.kamal@duke.edu.
Ryan D Nipp: Dana Farber Cancer Institute, Boston, Massachusetts, USA.
Janet H Bull: Four Seasons, Flat Rock, North Carolina, USA.
Charles S Stinson: Forsyth Medical Center Palliative Care Services, Winston-Salem, North Carolina, USA.
Ashlei W Lowery: Capital Caring, Falls Church, Virginia, USA.
Jonathan M Nicolla: Duke Center for Learning Health Care, Duke University Medical Center, Durham, North Carolina, USA.
Amy P Abernethy: Duke Center for Learning Health Care, Duke University Medical Center, Durham, North Carolina, USA; Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina, USA; Center for Palliative Care, Duke University Medical Center, Durham, North Carolina, USA; Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.
BACKGROUND: Measuring quality of care delivery is essential to palliative care program growth and sustainability. We formed the Carolinas Consortium for Palliative Care and collected a quality data registry to monitor our practice and inform quality improvement efforts. MEASURES: We analyzed all palliative care consultations in patients with cancer in our quality registry from March 2008 through October 2011 using 18 palliative care quality measures. Descriptive metric adherence was calculated after analyzing the relevant population for measurement. INTERVENTION: We used a paper-based, prospective method to monitor adherence for quality measures in a community-based palliative care consortium. OUTCOMES: We demonstrate that measures evaluating process assessment (range 63%-100%), as opposed to interventions (range 3%-17%), are better documented. CONCLUSIONS/LESSONS LEARNED: Analyzing data on quality is feasible and valuable in community-based palliative care. Overall, processes to collect data on quality using nontechnology methods may underestimate true adherence to quality measures.
