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Palliative and End-of-Life Care Quality Improvement Program
Kendell Cannon, MD, Medical Director, Stockton PACE Jane Venick, MSW, LCSW, Social Service Manager, Senior CommUnity Care of NC. PACE-NC
David Wensel, DO, Medical Director, Midland PACE
NPA PC/EOL Workgroup History
• Presentations at NPA Annual Conference
• Need to formalize multi-disciplinary group
<2014
• Workgroup established with five (5) original members
2015• Workgroup expanded to include
30 members • Initial focus on definitions and
guidelines • Presented on 10 Palliative and
End-of-Life Care Training Modules during NPA annual conference
2016
NPA PC/EOL Workgroup History
• Workgroup expanded to include 50 members
• Introduced Palliative and End-of-Life Care Bootcamp materials at annual conference
2017
• Workgroup expanded to include 60 members
• Advance Care Planning • Bereavement Programs • Presented two educational
sessions at NPA annual conference • Facilitated PC/EOL Workgroup
Resource Table
2018• Workgroup expanded to include
75 members • Role of Chaplain in PACE and End-
of-Life Care • Palliative and End-of-Life Care
Quality Improvement • Presented two educational
sessions at NPA annual conference
2019
• NPA Website• Member Resources• Participant Care Resources
https://www.npaonline.org/member-resources/participant-care-resources
How to Access Resources
NPA Contact: Mia Phifer
Vice President, Quality National PACE Association
How to become a member
Session Objectives
1. Increase understanding of the purpose and goals of the National PACE Association (NPA) Palliative and End-of-Life Care Workgroup.
2. Learn about resources available to PACE organizations to utilize in the development of an effective palliative and end-of-life care quality improvement program.
3. Be able to access guidelines and resources made available on the NPA website.
Project Overview : Objective
• To develop a measurement and monitoring system that PACE organizations can adopt to evaluate the effectiveness and impact of their palliative and end-of-life care programs.
• To provide resources and tools to assist PACE organizations to address quality and patient safety.
Project Overview : Program Components
•Performance Measurement•Data Analysis•Auditing and Monitoring Protocols•Quality Improvement Initiatives
Project Taskforce Members
• Kendell Cannon, MD, Medical Director, WelbeHealth Stockton (Chair) • [email protected]
• David Wensel, DO, Chief Medical Officer, Midland PACE• [email protected]
• Maria DePasquale RN, Palliative Care Manager, Community LIFE• [email protected]
• Jane Venick, Social Services Manager, Senior CommUnity Care of NC• [email protected]
• Sophie Le, Quality Improvement Coordinator, Stockton PACE• [email protected]
• Julie LaBelle, Quality Manager & Compliance Officer, PACE Central Michigan• [email protected]
• Cynthia Turner, RN-BC, The Basics at Jan Werner• [email protected]
Project Taskforce Members
• Peter DeGolia, MD, Medical Director, McGregor PACE• [email protected]
• Fatemeh Hashtroudi, Director of Quality Improvement, Community LIFE• [email protected]
• Ashton Andrews, LCSW, Elderhaus PACE• [email protected]
• Carol McGuire, Clinical Manager, PACE of the Southern Piedmont• [email protected]
• Margaret Moody, Quality Coordinator, PACE of the Southern Piedmont• [email protected]
• Christine Peterson Watts, Nurse Practitioner, Community Care, Inc.• [email protected]
Environmental Scan of Existing Measures
• National Quality Forum (NQF)• End-of-Life Care Measures• Hospice and Palliative Care Measures
• Center for Medicare and Medicaid Services (CMS)• Hospice Quality Reporting• PACE Quality Measures (draft)
• The Joint Commission• Palliative Care Measures
• American Academy of Hospice and Palliative Medicine• Hospice and Palliative Nurses Association
Performance Measurement Considerations
•Initial Evaluation (<2yrs. experience)•Advanced Evaluation (>2 yrs. experience)•Performance Measures•Data Sources •Resources
Performance Measurement: Advance Directives
Initial Evaluation: • Presence of state approved POST (Physician Order for Scope of Treatment),
POLST (Physician Order for Life Sustaining Treatment), MOST (Medical Orders for Scope of Treatment), or MOLST (Medical Orders for Life Sustaining Treatment) form or other form of form of written or oral statement by a participant about treatment preferences. Performance Measures:
• % of participants who have a state-approved POST/POLST/MOST/MOLST form or other form of written or oral statement by a participant about treatment preferences documented in the medical record and/or
• % of participants who have or have established a state-approved POST/POLST/MOST/MOLST or other approved written or oral statement by a participant about treatment preferences within XX days of enrollment.
Performance Measurement: Advance Directives
Advanced Evaluation: • Development of an advance care plan Performance Measures:
• Percentage of participants who have an advance care plan
• Percentage of participants who have an advance care plan established within XX days of enrollment
Performance Measurement: Advance Directives
Data Sources: • Electronic or paper clinical records Advance directive forms (e.g. POST, POLST, MOST, MOLST or other form
of written or oral statement by a participant about treatment preferences. Care plan documentation
Resources: • National POLST Paradigm: The national POLST initiative web site provides
guidance on use of Physician Orders for Life-Sustaining Treatment (POLST): http://polst.org/advance-care-planning/polst-and-advance-directives/
• Everplan’s State-by-State POLST Forms: https://www.everplans.com/articles/state-by-state-polst-forms
Performance Measurement: Pain Assessment and Management
Initial Evaluation: • Pain Assessment Performance Measures:
• Percentage of participants who were screened for the presence of pain using validated pain assessment tool, in accordance to POs policy
• Percentage of participants who were reassessed for pain in accordance with POs policy
Performance Measurement: Pain Assessment and Management
Best practice recommendations for pain assessment guidelines include screening for the presence of pain:
1.On initial contact with the participate, 2.Whenever other vital signs are assessed/recorded (blood
pressure, pulse, temperature, respiratory rate, etc.), 3.With any change in medical condition, 4.After providing treatment for pain, and 5.With any complaints of unrelieved pain.
Performance Measurement: Pain Assessment and Management
Advanced Evaluation: • Documentation of a comprehensive pain assessment AND
documentation of a care plan when pain is presentPerformance Measures:
• Percentage of participants who screen positive for pain and received a comprehensive assessment of pain within 24 hours of screening
• Percentage of participants who have a documented care plan when pain is present
Performance Measurement: Pain Assessment and Management
Data Sources: • Electronic or paper clinical records
• Pain Screening and assessment documentation• Care plan documentation
Resources: • Examples of tools for pain assessment, include, but are not limited to: Pain Assessment in
Advance Dementia Scale (PAINAD), Brief Pain Inventory (BPI), Faces Pain Scale (FPS), McGill Pain Questionnaire (MPQ), Multidimensional Pain Inventory (MPI), Neuropathic Pain Scale (NPS), Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), Verbal Descriptor Scale (VDS), Verbal Numeric Rating Scale (VNRS), and Visual Analog Scale (VAS), Patient-Reported Outcomes Measurement Information System (PROMIS).
• Veterans Health Administration Pain Management Toolkit: https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf
Performance Measurement: Place of Death
Initial Evaluation: • Location of participants’ place of death
• Performance Measures: The percentage of deaths that occurred in a hospital The percentage of deaths that occurred in a nursing home or
long-term care facility The percentage of deaths that occurred at a participant’s home The percentage of deaths that occurred in a hospice inpatient
setting
Performance Measurement: Place of Death
Advanced Evaluation: • Adherence to participant care preferences for place of
death Performance Measures:
• Percentage of participants with medical record documentation noting preference for place of death
• Percentage of participants who died in setting as specified by care preferences noted in medical record
Performance Measurement: Place of Death
Data Sources: • Electronic or paper clinical records Assessment documentation (e.g. physician, Nursing, SW
assessment forms) Advance directive forms (e.g. POST, POLST, MOST, MOLST) or
other approved written or oral statement by a participant about treatment preferences Care plan documentation
Resources: • NPA Advance Care Planning Resources
Quality Improvement Initiative
• See attached example
Quality Improvement Resources
• National Quality Forum• http://www.qualityforum.org/topics/palliative_care_and_end-of-life_care.aspx• http://www.qualityforum.org/measures_reports_tools.aspx
• The Joint Commission • https://manual.jointcommission.org/releases/TJC2018B1/PalliativeCare.html
• Institute for Healthcare Improvement• www.ihi.org
• Clinical Practice Guidelines for Quality Palliative Care• https://www.nationalcoalitionhpc.org/wp-content/uploads/2018/10/NCHPC-
NCPGuidelines_4thED_web_FINAL.pdf• Center to Advance Palliative Care (CAPC)
• https://www.capc.org/
Quality Improvement Resources
• Center for Medicare and Medicaid Services Measure Inventory Tool• https://cmit.cms.gov/CMIT_public/ListMeasures
• List of Clinically Tested and Validated Pain Scales• https://www.practicalpainmanagement.com/resource-centers/opioid-
prescribing-monitoring/list-clinically-tested-validated-pain-scales
• Department of Veterans Affairs: Pain as the 5th Vital Sign Toolkit• https://www.va.gov/PAINMANAGEMENT/docs/TOOLKIT.pdf
Thank you!
• Kendell Cannon, MD, Medical Director, Stockton PACE • [email protected]
• Jane Venick, MSW, LCSW, Social Service Manager, Senior CommUnity Care of NC. PACE-NC
• David Wensel, DO, Medical Director, Midland PACE • [email protected]
