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National Task Force Releases 10 Measures of Quality Palliative and Hospice Care

Doctors and Nurses Should ‘Measure What Matters’ When Treating Patients with Serious, Life-threatening Illnesses

Monday, February 16, 2015

"Patients deserve the very highest quality of palliative care we can provide.”

Patients with serious and life-threatening illnesses are less likely to experience unnecessary physical and emotional suffering if they receive palliative or hospice care that meets 10 key quality indicators, according to the findings of a two-year national project led by School of Nursing Independence Foundation Chair for Nursing/Palliative Care Sally A. Norton, Ph.D. R.N., F.P.C.N., F.A.A.N.  
The project, Measuring What Matters, is a joint initiative of the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Nurses Association (HPNA). The project’s findings and recommendations were published online today in the Journal of Pain and Symptom Management.
Measuring What Matters was launched to ensure palliative and hospice care patients across the country receive the highest quality care by identifying the 10 best existing indicators to gauge that care. The 10 measures range from a complete assessment (including physical, psychological, social, spiritual and functional needs) to a plan for managing pain and shortness of breath to having patients’ treatment preferences followed. They were selected from among 75 indicators largely based on what’s most important to patients and families.  
Palliative care aims to improve quality of life for patients who are being treated for a serious illness by managing pain and other symptoms. Hospice is a specific type of palliative care for patients in their last year of life.
The goal of the project was to select a set of measures that are scientifically rigorous, and that all palliative care clinicians should use to ensure they are providing the highest quality care. Eventually this will also enable benchmarking in the field. Currently there is no consistency regarding which measures are required by various groups, from accrediting organizations to payers. As the U.S. population ages, and the demand for this type of care grows, the ability to assess quality throughout the country and across care settings is increasingly important.
“We identified the best available set of measures to help us evaluate whether we are delivering the very highest quality care to patients who have palliative care needs and their families,” says Norton, who teamed with University of Pennsylvania School of Medicine Director of Palliative Care David J. Casarett, M.D., M.A., to lead a task force of 45 palliative care experts from across the country in the meticulous process of evaluating and winnowing hundreds of published quality measures. Casarett directs hospice and palliative care for the University of Pennsylvania Health System.
The Measuring What Matters team chose scientifically rigorous measures that meet three criteria: are meaningful for patients and their families, are able to be implemented by providers and can significantly improve the level of care. The team also collected input from patients, families, providers of palliative and hospice care, doctors and nurses, social workers and grief counselors.
“As a researcher, it is promising to me because this portfolio of measures will help us build the ‘science’ of palliative care, which is still young,” she says. “But much more importantly, we wanted to pinpoint the measures most meaningful to patients and families, and give providers tools they can use to systematically evaluate effectiveness, develop strategies to keep improving, and ensure that patients and families get the very best care possible.”
Norton says the panel also hopes that the focus on quality improvement will lead to more people receiving this important care. There are even greater numbers of people being treated for serious illnesses who would benefit from palliative care, but aren’t aware this type of care is available to help relieve symptoms, support their families and improve their quality of life.
The team identified the following top 10 Measures That Matter:
  1. Palliative care and hospice patients receive a comprehensive assessment (physical, psychological, social, spiritual and functional) soon after admission.
  2. Seriously ill palliative care and hospice patients are screened for pain, shortness of breath, nausea and constipation during the admission visit.
  3. Seriously ill palliative care and hospice patients who screen positive for at least moderate pain receive treatment (medication or other) within 24 hours.
  4. Patients with advanced or life-threatening illness are screened for shortness of breath and, if positive to at least a moderate degree, have a plan to manage it.
  5. Seriously ill palliative care and hospice patients have a documented discussion regarding emotional needs.
  6. Hospice patients have a documented discussion of spiritual concerns or preference not to discuss them.
  7. Seriously ill palliative care and hospice patients have documentation of the surrogate decision-maker’s name (such as the person who has healthcare power of attorney) and contact information, or absence of a surrogate.
  8. Seriously ill palliative care and hospice patients have documentation of their preferences for life-sustaining treatments.
  9. Vulnerable elders with documented preferences to withhold or withdraw life-sustaining treatments have their preferences followed.
  10. Palliative care and hospice patients or their families are asked about their experience of care using a relevant survey.
Project leaders also identified a number of other actions that need to be taken to ensure quality care, including: developing a method for identifying all patients who could benefit from palliative and hospice care; potentially setting up a registry of palliative and hospice care and working towards developing best practices; the creation of other needed measures, such as those to gauge social and cultural aspects of care; and development of a patient or family experience survey that is valid in all settings.
The Academy, representing 5,000 members, is the professional organization for physicians specializing in hospice and palliative medicine. Membership is also open to nurses and other health care providers who are committed to improving the quality of life of patients and families facing life-threatening or serious conditions. Since 1988, the Academy has dedicated itself to advancing hospice and palliative medicine and improving the care of patients with life-threatening or serious conditions. Visit to learn more.
About HPNA 
The Hospice and Palliative Nurses Association (HPNA) was established in 1986 and is the largest and oldest professional nursing organization dedicated to promoting excellence in Palliative Nursing. Established in 1986, HPNA has over 11,000 members and 50 chapters nationally. Together with the Hospice and Palliative Nurses Foundation and the National Board for Certification of Hospice and Palliative Nurses, it works to advance expert care in serious illness. Visit to learn more. 

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