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Defining Quality in Hospice

Hospice care in the United States has evolved rapidly over the past several decades. What began as a grass-roots movement to improve care of the dying soon became more and more uniform as best practices emerged and standardization of care became the norm. Numerous initiatives have led to the development of a framework of the essential components of hospice and palliative care, which later became the platform for reliable quality measures.

After reading this chapter, you will be able to:

DEFINING QUALITY

The Institute of Medicine (IOM) defined quality in care as “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (IOM, 2001). The IOM then established aims for quality care in the 21st century, noting that it should be:

■  Safe

■  Effective

■  Patient-centered

■  Timely

■  Efficient

■  Equitable

The aims developed by the IOM (2001) served as a call to action for health professionals in all settings. In hospice and palliative care, the National Consensus Project (NCP) was underway, leading to the release of a report regarding the provision of high-quality end-of-life care.

Fast Facts in a Nutshell

THE NCP

In 2001, the NCP was undertaken by a group of interprofessional palliative care experts who were dedicated to defining the domains of hospice and palliative care, as well as establishing guidelines for this specialty area. In 2004, this group released the landmark document Clinical Practice Guidelines for Quality Palliative Care. The eight domains of palliative care identified in the Clinical Practice Guidelines are as follows (Dahlin, 2013):

1.  Structure and Processes of Care: Describes the composition and qualifications of the interdisciplinary team and defines how the team should collaborate with patients and families.

2.  Physical Aspects of Care: Emphasizes the management of physical symptoms such as pain, fatigue, anxiety, and others.

3.  Psychological and Psychiatric Aspects of Care: Defines assessment of the psychosocial needs of patients and families. The requirement for bereavement support is included in this domain.

4.  Social Aspects of Care: Focuses on leveraging family strengths and social support mechanisms to alleviate family stress.

5.  Spiritual, Religious, and Existential Aspects of Care: Emphasizes the role of all members of the interdisciplinary team, especially the chaplain, in recognizing and addressing spiritual and existential distress. Specifically, the competency among all team members in understanding and supporting religious practice preferences of patients and families is stressed.

6.  Cultural Aspects of Care: Describes cultural competence and defines processes for the provision of culturally sensitive care.

7.  Care of the Patient at the End of Life: Highlights the importance of providing multidimensional interdisciplinary end-of-life care for patients and their families, which includes educating them and guiding them through the dying process.

8.  Ethical and Legal Aspects of Care: Addresses advance care planning, ethics, and legal aspects of care. The role of the interdisciplinary team in broaching end-of-life conversations and documenting patients’ preferences is stressed. Consultation with ethics committees and legal counsel is also emphasized.

The report from the NCP provided the first coherent account of what quality end-of-life care entailed. The Clinical Practice Guidelines were endorsed by the National Quality Forum (NQF) in 2006, lending further credence to this excellent work. The Clinical Practice Guidelines underpinned the provision of high-quality, uniform, end-of-life care across multiple practice settings and served as the foundation for many other hospice and palliative care initiatives and guidelines (Dahlin, 2015).

DEVELOPMENT OF HOSPICE GUIDELINES

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