This is a multi-data element measure consisting of four data elements: Q1: "I felt heard and understood by this provider and team," Q2: "I felt this provider and team put my best interests first when making recommendations about my care," Q3: "I felt this provider and team saw me as a person, not just someone with a medical problem," Q4: "I felt this provider and team understood what is important to me in my life."

Calculated using top-box scoring which reflects the percentage of patient respondents that give the most positive response across the four data elements. For all four questions in this measure, the top box numerator is the number of respondents who answer "Completely true."

calculation details: An individual's score can be considered an average of the four top-box responses and these scores are adjusted for mode of survey administration and proxy assistance. Individual scores are combined to calculate an average score for an overall palliative care program.

All patients aged 18 years and older who had an ambulatory palliative care visit. Ambulatory palliative care visit defined as: ICD-10 Z51.5 (Encounter for Palliative Care), OR Provider Hospice and Palliative Care Specialty Code 17; AND CPT 99201-99205 (New Office Visit); OR CPT 99211-99215 (Established Office Visit); or Place of service (POS) Code 11 – Office.

Denominator Exclusions: Patients who do not respond to at least one of the four data elements in the multidata element measure; Patients who do not complete the patient experience survey within 6 months of the eligible ambulatory palliative care visit; Patients who respond on the patient experience survey that they did not receive care by the listed ambulatory palliative care provider in the last 6 months (disavowal); Patients who were deceased when the survey reached them; Patients for whom a proxy completed the entire survey on their behalf for any reason (no patient involvement). Other exclusions: Proxy assistance is allowed. However, the patient must be involved in survey completion. Patients for whom a proxy completed the entire survey on their behalf for any reason (i.e., with no patient involvement, including patients who are deceased by the time the survey reaches them) are excluded.

Statistical risk model. Risk adjustment calculation (to be performed by CMS or its third-party intermediary) is used to estimate risk-adjusted program level measure scores, we utilise hierarchical generalised-linear models that relate the proportion of top-box patient-level outcome responses to program scores, conditioned on risk adjustment covariates (survey mode and proxy assistance).

None

Data sources: Patient medical records (paper-based or electronic) and patient-reported data and surveys. Patient eligibility is determined based on coded visit information in the electronic health record. Patient-reported data is collected via survey instrument. The instrument was developed for this measure and can be completed via Web survey, on paper, or over the telephone in English. A Spanish-language translation for the survey instrument is available, but the quality measures were not formally tested in Spanish. Information for the measure calculation is collected via a survey data collection instrument, which will be provided to the Centers for Medicare & Medicaid Services (CMS), to be made available to CMS- approved survey vendors and palliative care programs. Assessments of measure reliability based on the intraclass correlation coefficient (ICC) suggest that programs will need a sufficient sample to have at least 37 completed responses to the Heard and Understood items over the 12-month reporting period. An example data collection and reporting schedule that reflects the process used during testing: identification of all eligible visits during a 3-month or quarterly time-frame, and a subsequent 3- month survey administration/data collection time-frame, with data from all participating programs aggregated over a 12-month, or calendar year reporting period. The measure is composed of survey data representing patient report of care over a reporting period of one calendar year (January 1st to December 31st). The data should be collected from a sample of eligible palliative care patients that is representative of the palliative care provider or program within the designated time-frame.

The Level Of Analysis is performed at Group/Practice level. The score is reported as a rate/proportion. A higher score resulting from this measure should be interpreted, relative to a lower score, as representing better quality of care. Scores are reported at the program level aggregating results over a 12-month, or calendar year reporting period.

Gramling R, Stanek S, Ladwig S, Gajary-Coots E, Cimino J, Anderson W, et al. Feeling Heard and Understood: A Patient-Reported Quality Measure for the Inpatient Palliative Care Setting. J Pain Symptom Manage. 2016; 51(2):150-4. www.jpsmjournal.com/article/S0885-3924(15)00607-7/fulltext Edelen MO, Rodriguez A, Huang W, Gramling R, Ahluwalia SC. A novel Scale to Assess Palliative Care Patients' Experience of Feeling Heard and Understood. J Pain Symptom Manage. 2022 May;63(5):689-697.e1. doi: 10.1016/j.jpainsymman.2022.01.002

Brief version: www.nationalcoalitionhpc.org/qualitymeasures/ Full specifications: aahpm.org/uploads/AAHPM22PRO-PMIMPLEMENTATION_GUIDE.pdf, www.nationalcoalitionhpc.org/wp-content/uploads/2021/11/MIF-Feeling-Heard-and-Understood.pdf

Related to NQF item #3665