Quality Indicator Repository

The Hospice Comprehensive Assessment Measure assesses the percentage of hospice stays in which patients who received a comprehensive patient assessment at hospice admission. The measure focuses on hospice patients age 18 years and older. A total of seven individual National Quality Framework endorsed components of quality will provide the source data for this comprehensive assessment measure. These seven measures focus on care processes around hospice admission that are clinically recommended or required in the hospice Conditions of Participation, including patient preferences regarding life-sustaining treatments, care for spiritual and existential concerns, and management of pain, dyspnoea, and bowels.

Hospice: Percentage of patients enrolled for more than seven days for whom a comprehensive assessment was completed within five days of admission (documentation of prognosis, functional assessment, screening for physical and psychological symptoms, and assessment of social and spiritual concerns).

Seriously ill patients receiving specialty palliative care in an acute hospital setting: Percent of all patients admitted for more than one day who had comprehensive assessment (screening for physical symptoms and discussion of the patient/family's emotional or psychological needs) completed within 24 hours of admission.

The Hospice Care Index (or HCI) is an index measure; it scores hospices on a 0 to 10 scale using ten Medicare claims-based indicators which capture a broad array of information on hospice service provision. The HCI provides information that reflects care processes during a hospice stay and allows patients, families, and caregivers to make informed decisions. Collectively these indicators represent different aspects of hospice service and thereby characterise hospices comprehensively, rather than on just a single care dimension. Each indicator equally affects the single HCI score, reflecting the equal importance of each aspect of care delivered from admission to discharge.

This summary indicator includes 5 questions covering families and others needs, emotional, practical, spiritual, religious and cultural support and being informed about the patient's condition and treatment. All questions include response options on a 5-point Likert-scale (Strongly agree, Agree, Neither agree not disagree, Disagree, Strongly disagree or N/A/Not sure). Questions include: I was asked about my needs; I was given enough emotional help and support by staff; I was given enough practical support (for example with finding refreshments and parking arrangements); I was given enough spiritual/religious/cultural support; I was kept well informed and had enough opportunity to discuss their condition and treatment with staff.

Number and proportion (%) of specialist palliative care providers participating in national benchmarking.

Number of participating institutions in the National Guidelines for Palliative Care (NGPC) biennial assessments for specialised and general palliative care providers.

Proportion of institutions achieving set minimum standards (80% and above all domains, including psycho-social-spiritual domains).

Proportion of specialised palliative care healthcare professionals being rotated to community setting for community exposure.

When you consider all aspects of your life—physical,psychological, social, spiritual, existential, and financial—your quality of life over the past 2 days was:(very bad) 0 ———————— 10 (excellent)

Individual survey item included as part of the CAHPS® Hospice Survey asking respondents: "Using any number from 0 to 10, where 0 is the worst hospice care possible and 10 is the best hospice care possible, what number would you use to rate your family member's hospice care?" Response options are on a 0-10 rating scale, with 0=Worst hospice care possible and 10=Best hospice care possible.

This staff-reported summary measure includes 11 questions regarding staff confidence in delivering end of life care: I am confident I can recognise when a patient might be dying imminently (within hours to days); I feel confident in my skills to communicate clearly and sensitively to dying patients and those important to them; I am confident I have the skills to involve the dying patient and those important to them in decisions about end of life care in line with their wishes and preferences; I know how to access specialist palliative care advice, if required, when addressing specific end of life care needs for dying patients; I know how to respond to requests to die outside of the hospital setting from dying people and/or those important to them; I feel confident to respond to the practical and social needs of the dying person; I feel confident to respond to the spiritual, emotional and cultural needs of the dying person; I am confident in my ability to discuss hydration options with dying patients and those important to them; I am confident in assessing and managing patient pain and physical symptoms at the end of life; I feel confident to respond to the practical and social needs of those important to the dying person; I feel confident to respond to the spiritual, emotional and cultural needs of those important to the dying person.