MacMartin Meredith A, Nano Joseph P, Richard Elodie, Garland Melissa, Johnson Kristen, Kirkland Kathryn, Mathewson Barbara, Thibideau Mary, Saunders Catherine H
Dartmouth Hitchcock Medical Center (M.A.M., J.P.N., M.G., K.J., K.K., B.M., M.T., C.H.S.), Lebanon, New Hampshire, USA; Geisel School of Medicine (M.A.M., J.P.N., E.R., K.K., C.H.S), Hanover, New Hampshire, USA.
Dartmouth Hitchcock Medical Center (M.A.M., J.P.N., M.G., K.J., K.K., B.M., M.T., C.H.S.), Lebanon, New Hampshire, USA; Geisel School of Medicine (M.A.M., J.P.N., E.R., K.K., C.H.S), Hanover, New Hampshire, USA.
J Pain Symptom Manage. 2025 Jul;70(1):e73-e80. doi: 10.1016/j.jpainsymman.2025.04.001. Epub 2025 Apr 9.
Despite recognition of the importance of measuring the quality of palliative care, there are significant gaps in information about how to do so in real-world settings, particularly for patient-reported experience measures (PREMs).
To institute a routine process of quality measurement using PREMs to support quality improvement and service recovery, in a single center inpatient palliative care unit in the United States.
Volunteers with prior healthcare experience administered two PREMs: consideRATE (a measure of patient serious illness experience) and integRATE (a measure of healthcare team integration). We calculated both item and overall mean scores, and top-box scores to mitigate potential ceiling effects. Negative or critical complaints were promptly brought to the unit nurse manager for real-time service recovery.
The overall mean consideRATE score was 3.88 (highest score possible of 4), and the overall mean integRATE score was 3.91 (highest score possible of 4). Top-box scores were 70% for consideRATE, and 75% for integRATE. The majority of the feedback given was positive. Opportunities for improvement of the unit environment, communication with patients and families, and the nursing and medical care, were identified. In some cases, critical feedback was acted on in real time to allow for service recovery.
Using consideRATE and integRATE in routine care is feasible, allows for effective identification of patient and family concerns about care, and should be considered for other palliative care settings.
尽管人们认识到衡量姑息治疗质量的重要性，但在实际环境中，关于如何进行衡量的信息仍存在重大差距，尤其是在患者报告体验测量（PREMs）方面。
在美国的一个单中心住院姑息治疗病房，建立一个使用PREMs进行质量测量的常规流程，以支持质量改进和服务恢复。
有医疗保健经验的志愿者实施了两项PREMs：consideRATE（一种衡量患者重病体验的指标）和integRATE（一种衡量医疗团队整合的指标）。我们计算了项目平均分和总体平均分以及顶级分数，以减轻潜在的天花板效应。负面或关键投诉会立即提交给病房护士长以进行实时服务恢复。
consideRATE的总体平均分为3.88（满分4分），integRATE的总体平均分为3.91（满分4分）。consideRATE的顶级分数为70%，integRATE为75%。给出的反馈大多是积极的。确定了病房环境、与患者和家属沟通以及护理和医疗方面的改进机会。在某些情况下，关键反馈得到了实时处理以实现服务恢复。
在常规护理中使用consideRATE和integRATE是可行的，能够有效识别患者和家属对护理的担忧，其他姑息治疗环境也应考虑采用。
