Performance Measures

In the summer of 2013, HPNA and AAHPM partnered on Measuring What Matters, a consensus project aimed at identifying a recommended portfolio of cross-cutting performance measures for all hospice and palliative care programs.

The TAP assisted in identifying measures to be prioritized, judging the technical strength of existing measures (such as reliability and validity), and helping with denominator creation. 

The CUP prioritized measures based on their importance and usefulness to field.

The project panelists sorted through the dozens of published quality measures for hospice and palliative care to select a small portfolio of recommended measures for use across all settings. Voluntary adoption of these measures broadly in hospice and palliative care would lay the groundwork for benchmarking and meaningful comparison.

1. Seventy-five published performance indicators were mapped to the domains of the National Consensus Project (NCP).
2. The Technical Advisory Panel (TAP) rated the indicators (measures) on their scientific soundness and referred a set of measures (n=34) for review by the Clinical User Panel (CUP).
3. The CUP rated those measures based on three dimensions of importance: How MEANINGFUL is this for patients/families? How ACTIONABLE is this for providers/organizations? How large is the POTENTIAL IMPACT?
4. The CUP achieved consensus on their top twelve initial published measures.
5. The draft list of twelve measures was sent to HPNA and AAHPM members and their interdisciplinary teams, as well as organizations and patient advocacy groups, to elicit feedback.
6. Feedback was received from 264 individuals and 27 organizations.
7. The top ten measures were selected.

• Access the Top Ten Measures That Matter:  Actual Measures List or Measure Concepts List   
• Access the New Frequently Asked Questions (FAQ) List about MWM 

Take manageable steps that align with your existing measurement requirements. Identify priorities in your setting to evaluate and improve. Perhaps start with two or three measures that best fit your program, capacity, and improvement goals. For hospices, it may be those already in the Hospice Item Set; others might use MWM measures to meet accreditation or maintenance of certification. Resources to help get started in quality measurement include:

• PEACE Measures
• Institute for Healthcare Improvement (IHI) Open School
• BMJ Quality Learning Modules

• Access the Overall Frequently Asked Questions (FAQ) List about MWM.
• Access the Top Twelve Measures – Background information, evidence, and CUP comments
• Access the AAHPM Measuring What Matters web page for additional information. 

HPNA and AAHPM convened a Measuring What Matters (MWM) strategy meeting in December 2014 to generate a timeline and framework to guide their quality initiatives over the next five years. Both organizations gathered a number of groups active in improving quality in hospice and palliative care, including The Joint Commission, Community Health Accreditation Partner (CHAP), National Hospice and Palliative Care Organization (NHPCO), Center to Advance Palliative Care (CAPC), National Palliative Care Research Center (NPCRC), Palliative Care Research Cooperative Group (PCRC), Global Palliative Care Quality Alliance (QDACT), Palliative Care Quality Network (PCQN), The United States Department of Veteran Affairs (VA), the CHOICE Network, and the Home-based Primary Care and Palliative Care Network.

In phase two of Measuring What Matters, the project will take on more complex tasks, such as creating e-specifications and patient-reported outcome measures, field-testing altered, expanded, or untested measures, and developing a common palliative care denominator. Additionally, we are investigating collaborations, strategic alliances and funding, and developing a companion paper to MWM on quality research priorities. The meeting participants also identified six areas of creative tension in developing a quality strategy for our field:

• Process or outcome measures?
• Specialty focus or primary care focus?
• Perfection or pragmatism?
• Quality improvement or accountability?
• Hospice or palliative care?
• Medical model or multidisciplinary?

Panel Chairs and Members

• Co-Chair: David Casarett, MD, MA
• Co-Chair: Sally Norton, PhD, RN, FNAP, FPCN, FAAN

Technical Advisory Panel

• Co-Chair: Sydney Dy, MD
• Co-Chair: Susan McMillan, PhD, ARNP, FAAN
• Marie Bakitas, DNSc, APRN, NP-C, AOCN, ACHPN®, FAAN
• Teresa Craig, CPA
• Mary Ersek, PhD, RN, FAAN
• Chris Feudtner, MD, PhD, MPH
• Laura Hanson, MD, MPH
• Arif Kamal, MD
• Lisa Lindley, PhD, RN
• Karl Lorenz, MD, MSHS
• Carol Spence, PhD
• Martha Tecca, MBA
• Joan Teno, MD, MS

Clinical User Panel

• Co-Chair: Keela Herr, PhD, RN, AGSF, FAAN
• Co-Chair: Joe Rotella, MD, MBA, FAAHPM
• Michael Balboni, PhD, ThM, MDiv
• Patricia Berry, PhD, RN, ACHPN®, FPCN, FAAN
• Cynthia Boyd, MD, MPH
• Janet Bull, MD
• Ira Byock, MD
• Barbara Daly, PhD, RN, FAAN
• Kenneth Doka, PhD
• Jennifer Eurek, CSW
• Joy R. Goebel, RN, PhD
• Elizabeth Gundersen, MD, FHM
• Krista Lyn Harrison, PhD
• Joan Harrold, MD, MPH, FACP, FAAHPM
• Jean Kutner, MD, MSPH
• Thomas Lee, MD
• Kelly McCutcheon Adams, LICSW
• Deirdre Mylod, PhD
• Marsha H. Nelson, ACSW, MBA
• Lynn Reinke, PhD, ARNP
• Christine Ritchie, MD, MSPH, FAAHPM
• Eugenia Smither, RN, BS, CHC, CHE, CHP
• Lisa Stephens, MSN, APRN, ACHPN®
• Rodney Tucker, MD, MMM, FAAHPM
• Deborah Waldrop, LMSW, PhD
• Joanne Wolfe, MD, MPH