RTI International, Research Triangle Park, North Carolina, USA.
RTI International, Research Triangle Park, North Carolina, USA.
J Pain Symptom Manage. 2018 Feb;55(2):427-432.e1. doi: 10.1016/j.jpainsymman.2017.09.016. Epub 2017 Oct 10.
With increasing use of the Medicare hospice benefit, policymakers recognize the need for quality measurement to assure that terminally ill patients receive high-quality care and have the information they need when selecting a hospice. Toward these goals, Centers for Medicare & Medicaid Services has been collecting standardized patient-level quality data via the Hospice Item Set (HIS) since July 1, 2014.
This article presents a first look at the national hospice HIS quality data.
We calculated seven quality measures using the HIS data. These measures are endorsed by the National Quality Forum and focus on important care processes hospice providers are required to perform at admission, including discussion of patient preferences regarding life-sustaining treatments, care for spiritual and existential concerns, and symptom management (pain, opioid-induced constipation, and dyspnea).
Our sample included 1,218,786 hospice patients discharged from 3922 hospices from October 1, 2014 to September 30, 2015. More than 90% of patients received screenings and assessments captured by six of the seven quality measures. The only exception was pain assessment, for which the national mean score was 78.2%. A small number of hospices (156, 4.0%) had perfect scores for all seven quality measures.
Most hospices conduct critical assessments and discuss treatment preferences with patients at admission, although few hospices have perfect scores.
随着医疗保险临终关怀福利的使用日益增加，政策制定者认识到需要进行质量衡量，以确保终末期患者获得高质量的护理，并在选择临终关怀服务时拥有所需的信息。为此，医疗保险和医疗补助服务中心自 2014 年 7 月 1 日起通过临终关怀项目集（HIS）收集标准化的患者层面的质量数据。
本文首次介绍了全国性的临终关怀 HIS 质量数据。
我们使用 HIS 数据计算了七个质量指标。这些指标得到了国家质量论坛的认可，重点关注临终关怀提供者在入院时必须执行的重要护理流程，包括讨论患者对维持生命治疗的偏好、对精神和存在问题的护理，以及症状管理（疼痛、阿片类药物引起的便秘和呼吸困难）。
我们的样本包括 2014 年 10 月 1 日至 2015 年 9 月 30 日期间从 3922 家临终关怀机构出院的 1,218,786 名临终关怀患者。超过 90%的患者接受了七个质量指标中六个指标所涵盖的筛查和评估。唯一的例外是疼痛评估，全国平均得分仅为 78.2%。只有一小部分临终关怀机构（156 家，占 4.0%）在所有七个质量指标上都获得了满分。
尽管少数临终关怀机构（占 4.0%）在所有七个质量指标上都获得了满分，但大多数临终关怀机构在入院时都会对患者进行关键评估并讨论治疗偏好。
