The PEACE Project: identification of quality measures for hospice and palliative care.

CONTEXT

In 2008, the Centers for Medicare & Medicaid Services (CMS) required U.S. hospices to implement comprehensive quality improvement programs. CMS contracted with the Quality Improvement Organization in North and South Carolina to develop quality measures and instruments to assess hospice and palliative care quality.

OBJECTIVES

To develop a set of quality measures, with complete specifications, and data collection tools for use by hospice and palliative care providers in quality improvement.

METHODS

Quality measures were identified from: published literature, the National Quality Forum, CMS measures, the National Quality Measures Clearinghouse, and measures submitted by two national hospice organizations. Available data on the quality measures were gathered and pilot data were collected for measures with no available data. A Technical Expert Panel (TEP) rated quality measures on: importance, scientific soundness, feasibility and usability, using numeric scores for each dimension. Scores for quality measures were averaged across dimensions and across TEP members to identify measures for further development.

RESULTS

Of 174 measures identified, 88 were determined appropriate to the setting and were reviewed and rated by the TEP. Measures with overall scores ≥75th percentile (n = 23), measures with high importance scores (n = 7), measures for under-represented domains (n = 2), and process measures antecedent to TEP identified measures (n = 2), and were selected.

CONCLUSIONS

Specifications and data collection tools are available for 34 PEACE quality measures that were highly rated by experts in hospice and palliative care. Future research should assess the scientific soundness and responsiveness of these measures to quality improvement.