J Pain Symptom Manage. 2014 Jul 21. pii: S0885-3924(14)00362-5. doi: 10.1016/j.jpainsymman.2014.06.008. [Epub ahead of print]

The Quality Imperative for Palliative Care.

Kamal AH1, Hanson LC2, Casarett DJ3, Dy SM4, Pantilat SZ5, Lupu D6, Abernethy AP7.

Author information

• 1Duke Cancer Institute, Duke University Medical Center and Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina. Electronic address: arif.kamal@duke.edu.
• 2Division of Geriatric Medicine, University of North Carolina, Chapel Hill, North Carolina.
• 3Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
• 4Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
• 5Palliative Care Program, Division of Hospital Medicine, University of California, San Francisco, California.
• 6Center for Aging, Health and Humanities, George Washington University, Washington, DC, USA.
• 7Duke Cancer Institute, Duke University Medical Center and Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.

Abstract

Palliative medicine must prioritize the routine assessment of the quality of clinical care we provide. This includes regular assessment, analysis, and reporting of data on quality. Assessment of quality informs opportunities for improvement and demonstrates to our peers and ourselves the value of our efforts. In fact, continuous messaging of the value of palliative care services is needed to sustain our discipline; this requires regularly evaluating the quality of our care. As the reimbursement mechanisms for health care in the United States shift from fee-for-service to fee-for-value models, palliative care will be expected to report robust data on quality of care. We must move beyond demonstrating to our constituents (including patients and referrers), "here is what we do," and increase the focus on "this is how well we do it" and "let's see how we can do it better." It is incumbent on palliative care professionals to lead these efforts. This involves developing standardized methods to collect data without adding additional burden, comparing and sharing our experiences to promote discipline-wide quality assessment and improvement initiatives, and demonstrating our intentions for quality improvement on the clinical frontline.