Department of Medicine, Division of Geriatric Medicine and Palliative Care Program, University of North Carolina, Chapel Hill, North Carolina 27599-7550, USA.
J Pain Symptom Manage. 2010 Jan;39(1):1-8. doi: 10.1016/j.jpainsymman.2009.09.003.
Hospice and palliative care organizations need to measure and analyze quality of care, in response to national palliative care practice guidelines and new hospice regulatory requirements. Little is known about hospices' readiness to meet this new mandate.
We analyzed data from a national survey of hospices to describe preparation and practices for quality measurement and research and to examine associated organizational characteristics.
Web-based survey of hospice staff responsible for quality of care.
Survey respondents represented 652 National Hospice and Palliative Care Organization (NHPCO) member hospice organizations; 52% were participating in the NHPCO Quality Partners program. Most of these hospices involve clinical providers in decisions to change care practices (69%) and participate in quality improvement projects (64%), but research participation is uncommon (16%). Many hospices collect data about staff certification and training (76%) and use family surveys to measure care quality (70%). A minority of hospices have clinical data in electronic format (13%-29%). Large size, multiple sites, government ownership, and presence of a change leader in the organization were the characteristics associated with greater preparation for quality improvement and research.
Current organizational activities, data collection rates, and use of electronic data systems may limit hospices' preparation and practices related to quality improvement and research participation; larger size and designation of a change leader are associated with greater capacity. Hospices may need technical assistance and training to provide for meaningful measurement of quality of care.
为了响应国家缓和医疗实践指南和新的临终关怀监管要求，临终关怀和姑息治疗组织需要衡量和分析护理质量。临终关怀组织是否准备好迎接这一新任务，目前知之甚少。
我们分析了一项针对临终关怀机构的全国性调查数据，以描述其在质量衡量和研究方面的准备情况和实践，并探讨相关的组织特征。
对负责护理质量的临终关怀工作人员进行基于网络的调查。
调查对象代表了 652 家全国临终关怀和姑息治疗组织协会（NHPCO）成员临终关怀机构；其中 52% 正在参与 NHPCO 质量合作伙伴计划。这些临终关怀机构大多让临床医生参与改变护理实践的决策（69%），并参与质量改进项目（64%），但很少参与研究（16%）。许多临终关怀机构收集有关员工认证和培训的数据（76%），并使用家庭调查来衡量护理质量（70%）。少数临终关怀机构拥有电子格式的临床数据（13%-29%）。组织规模较大、拥有多个地点、由政府拥有或存在变革领导者是与质量改进和研究参与准备更充分相关的特征。
目前的组织活动、数据收集率和电子数据系统的使用可能限制了临终关怀机构在质量改进和研究参与方面的准备和实践；规模较大和指定变革领导者与更大的能力相关。临终关怀机构可能需要技术援助和培训，以提供有意义的护理质量衡量。
