Palliative care benchmarks from academic medical centers.
BACKGROUND
Palliative care is growing in the United States but little is known about the quality of care delivered.


OBJECTIVE
To benchmark the quality of palliative care in academic hospitals.


METHODS
Multicenter, cross-sectional, retrospective chart review conducted between October 1, 2002 and September 30, 2003.


METHODS
Thirty-five University HealthSystem Consortium (UHC) academic hospitals across the United States.


METHODS
A total of 1596 patient records.


METHODS
(1) adults, (2) high-mortality diagnoses: selected cancers, heart failure, human immunodeficiency virus (HIV), and respiratory conditions requiring ventilator support, (3) length of stay (LOS) more than 4 days, and (4) two prior admissions in the preceding 12 months.


METHODS
Compliance with 11 key performance measures (KPM) derived from practice standards, literature evidence, and input from a multidisciplinary expert committee. Analyses examined relationships between provision of the KPM and specific outcomes.


RESULTS
Wide variability exists among academic hospitals in the provision of the KPM (0%-100%). The greater the compliance with KPM, the greater the improvement in quality outcomes, cost and LOS. Assessment of pain (96.1%) and dyspnea (90.2%) was high, but reduction of these symptoms was lower (73.3% and 77.2%). Documentation of prognosis (33.4%), psychosocial assessment (26.2%), communication with family/patient (46%), and timely planning for discharge disposition (53.4%) were low for this severely ill population (16.8% hospital mortality). Only 12.9% received a palliative care consultation.


CONCLUSIONS
The study reveals significant opportunities for improvement in the effective delivery of palliative care. Care that met KPM was associated with improved quality, reduced costs and LOS. Institutions that benchmarked above 90% did so by integrating KPM into daily care processes and utilizing systematized triggers, forms and default pathways. The presence of a formalized palliative care program within a hospital system had a positive effect on the achievement of KPM, whether or not formal consultation occurred. Hospitals need to develop systematic methods to improve access to palliative care.
Twaddle
Martha L
ML
Midwest Palliative & Hospice CareCenter, 2050 Claire Court, Glenview, IL 60025, USA. mtwaddle@carecenter.org
Maxwell
Terri L
TL
Cassel
J Brian
JB
Liao
Solomon
S
Coyne
Patrick J
PJ
Usher
Barbara M
BM
Amin
Alpesh
A
Cuny
Joanne
J
D000046:Academic Medical Centers / Q000592:standards*; D000328:Adult; D000368:Aged; D019985:Benchmarking; D003422:Critical Care / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D010166:Palliative Care / Q000592:standards*; D010359:Patient Readmission; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States