• Institute for Clinical Systems Improvement (ICSI). Palliative care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 May. 58 p. [113 references]

Does not apply to this measure

This measure is used to assess the percentage of adult patients with a progressive, debilitating disease who have a palliative care plan documented in the medical record.

The priority aim addressed by this measure is to increase palliative care planning with patients who have been identified in the early stages of a progressive, debilitating disease.

Palliative care; progressive, debilitating disease

Total number of adult patients with the specified progressive, debilitating disease (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Number of adult patients with the specified progressive, debilitating disease who have a palliative care plan in chart (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

Unspecified

Current routine use

Internal quality improvement

Home Care
Hospices
Hospitals
Long-term Care Facilities
Physician Group Practices/Clinics

Advanced Practice Nurses
Nurses
Physicians
Social Workers

Group Clinical Practices

Adults

Either male or female

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

End of Life Care
Living with Illness

Effectiveness
Patient-centeredness

Users of care only

Adult patients with a diagnosis of a progressive, debilitating disease

A random sampling of at least 10 adult patients with a specified progressive, debilitating disease seen each month.

Medical records are reviewed to determine whether there is any evidence of a palliative care plan in place.

Patients associated with provider

Inclusions
Total number of adult patients with the specified progressive, debilitating disease

Note: "Specified progressive, debilitating disease" needs to be predetermined by the medical group prior to data collection. This measure is applicable to any and all progressive, debilitating disease. These include, but are not limited to:

• Pulmonary disease
• Cancer/neoplasm
• Liver disease
• Renal disease
• Neurological disorders:
  • Stroke
  • Parkinson's
  • Amyotrophic lateral sclerosis
  • Multiple sclerosis

Exclusions
Unspecified

All cases in the denominator are equally eligible to appear in the numerator

Clinical Condition

Time window is a single point in time

Inclusions
Number of adult patients with the specified progressive, debilitating disease who have a palliative care plan* in chart

*A completed palliative care plan addresses all seven domains of care: physical aspects, cultural aspects, psychological aspects, social aspects, spiritual/religious/existential aspects, ethical/legal aspects, and care of the imminently dying patient.

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Episode of care

Medical record

Individual Case

Unspecified

Rate

Better quality is associated with a higher score

Unspecified

Internal time comparison

Unspecified

Percentage of adult patients with a progressive, debilitating disease who have a palliative care plan documented in the medical record.

Institute for Clinical Systems Improvement

The following Minnesota health plans provide direct financial support: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica, Metropolitan Health Plan, PreferredOne and UCare Minnesota. In-kind support is provided by the Institute for Clinical Systems Improvement's (ICSI) members.

Work Group Members: Howard Epstein, MD (Work Group Leader) (HealthPartners-Regions Hospital) (Internal Medicine/Palliative Care); Rob Ruff, BCC (HealthPartners Regions Hospital) (Chaplain); Kristina Schlecht, MD (Dakota Clinic) (Family Medicine); Lyn Ceronsky, APRN, MS (Fairview Health Services) (Family Medicine/Geriatrics); Ken Kephart, MD (Fairview Health Services) (Family Medicine/Geriatrics); Mabel Rohr, CNP (HealthPartners Medical Group) (Family Medicine/Geriatrics); Nancy Joyner, ACHPN (Altru Health System) (Family Medicine/Palliative Care); Becky Nosan, NP (Allina Medical Clinic) (Family Medicine/Palliative Care); Sara Shorter, MD (Hutchinson Medical Center) (Family Medicine/Palliative Care); Martha McCusker, MD, FACP (Hennepin County Medical Center) (Internal Medicine/Geriatrics); Kevin Panico, MD (Altru Health System) (Oncology); Dianne Brundage, PharmD (Park Nicollet-Methodist) (Pharmacist); Sheila Skeels, LICSW (Winona Health) (Social Worker); Janet Jorgenson-Rathke, PT (Institute for Clinical Systems Improvement) (Measurement/Implementation Advisor); Linda Setterlund, MA, CPHQ (Institute for Clinical Systems Improvement) (Facilitator)

The Institute for Clinical Systems Improvement (ICSI) has adopted a policy of transparency, disclosing potential conflict and competing interests of all individuals who participate in the development, revision and approval of ICSI documents (guidelines, order sets and protocols). This applies to all work groups (guidelines, order sets and protocols) and committees (Committee on Evidence-Based Practice, Cardiovascular Steering Committee, Women's Health Steering Committee, Preventive & Health Maintenance Steering Committee, Respiratory Steering Committee and the Patient Safety & Reliability Steering Committee).

Participants must disclose any potential conflict and competing interests they or their dependents (spouse, dependent children, or others claimed as dependents) may have with any organization with commercial, proprietary, or political interests relevant to the topics covered by ICSI documents. Such disclosures will be shared with all individuals who prepare, review and approve ICSI documents.

No work group members have potential conflicts of interest to disclose.

Measure was not adapted from another source.

2008 May

This is the current release of the measure.

• Institute for Clinical Systems Improvement (ICSI). Palliative care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 May. 58 p. [113 references]

This NQMC summary was completed by ECRI Institute on June 30, 2008.

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization. If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties.

If the abstracted ICSI Measures are downloaded by an organization, copies may be distributed to the organization's employees but may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved by the Institute for Clinical Systems Improvement, Inc. The Institute for Clinical Systems Improvement, Inc. assumes no liability for any adaptations or revisions or modifications made to the abstracts of the ICSI Measures.