title: Can we make reports of end-of-life care quality more consumer-focused? results of a nationwide quality measurement program.
abstract: OBJECTIVE
  The goal of this study was to define families' priorities for various aspects of end-of-life care, and to determine whether scores that reflect these priorities alter facilities' quality rankings.
  
  
  METHODS
  Nationwide telephone survey.
  
  
  METHODS
  62 VA medical centers, including acute and long term care.
  
  
  METHODS
  For each patient who died in a participating facility, one family member was invited to participate.
  
  
  METHODS
  A survey included 14 items describing key aspects of the patient's care in his or her last month of life, and one global rating. A weighted score was calculated based on the association between each item and the global rating.
  
  
  RESULTS
  Interviews were completed with family members for 3,897 of 7,110 patients (55%). Items showed an approximately 5-fold range of weights, indicating a wide variation in the importance that families placed on aspects of palliative care (low: pain management, weight = 0.54, 95% CI 0.38-0.70;/P/<0.001; high: providers were "kind, caring, and respectful: weight = 2.46, 95% CI 2.24-2.68;/P/<0.001). Weights were homogeneous across patient subgroups, and there were no significant changes in facilities' quality rankings when weights were used. Both weighted and unweighted scores showed similar evidence of the impact of process measures.
  
  
  CONCLUSIONS
  There appears to be wide variation in the importance that families place on several aspects of end-of-life care. However, the impact of weighting was generally even across patient subgroups and facilities. Therefore, the use of weights to account for families' priorities is not likely to alter a facility's quality score.
authors.affiliation: Center for Health Equity Research and Promotion, Department of Veterans Affairs Medical Center , Philadelphia, Pennsylvania, USA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Smith
authors.forename: Nicole
authors.initials: N
authors.lastname: Caragian
authors.forename: Elena
authors.initials: E
authors.lastname: Kazlo
authors.forename: Jennie
authors.initials: J
authors.lastname: Bernstein
authors.forename: Diane
authors.initials: D
authors.lastname: Richardson
authors.forename: David
authors.initials: D
authors.lastname: Casarett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003258:Consumer Behavior; D005190:Family; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000379:methods*; D013727:Terminal Care / Q000592:standards*; D014481:United States