Engaging Hospices in Quality Measurement and Improvement: Early Experiences of a Large Integrated Health Care System

Abstract

The quality of hospice care remains highly variable in the U.S. Patients, providers, and health care systems lack a comprehensive method of measuring the quality of care provided by an individual hospice. Partners HealthCare sought to assess hospice quality based on objective and quantitative criteria obtained directly from hospices and through public reporting. Here, we describe the process of creating and administering this assessment and the initial creation of a collaborative network with high-quality hospices. A multidisciplinary advisory council developed criteria and a scoring system, focusing on organizational information (e.g., nursing turnover), clinical care quality indicators (e.g., visit hours before death), and training (e.g., medical director certification) and satisfaction (e.g., patient and family surveys). All Medicare-certified hospices in good standing in Massachusetts were eligible to participate in a request for information (RFI) process. We blinded data before scoring and invited hospices scoring above the 15th percentile to join the initial collaborative. Of 72 eligible hospices, most (53%) responded to the RFI, and 32% (n = 23) submitted completed surveys. Hospices could receive up to 23.75 points, and scores ranged from 2.25 to 19.5. The median score was 13.62 (interquartile range 10.5-16.75). For hospices scoring above the 15th percentile (n = 19), scores ranged from 10.0 to 19.5 (median 14). The hospice RFI process is one health care system's attempt to evaluate hospice quality. Further research will determine whether the scoring system proves to be a sensitive, specific, and reproducible measure of hospice quality, and whether the collaborative can foster quality improvement over time.

Keywords: Hospice; care transitions; health care systems; quality improvement; quality measurement.