Center to Advance Palliative Care

There is a need to find a way to remove persons who are very sick or who have a short life expectancy from certain quality measures. Consider, for example, mammograms and colon cancer screening. Keeping everyone in the denominator creates a pressure to waste money and incur other burdens in screening people who are very unlikely to benefit. In Britain, persons registered in the Gold Standards Registers in their Primary Care Trusts are removed from this sort of performance measure. The Gold Standards Framework [http://www.gsfs.scot.nhs.uk/ or http://www.goldstandardsframework.org.uk/] relies mostly on the "no surprise" question: is this patient sick enough that it would be no surprise if the person died in the coming year? If so, then the primary care provider puts this into their Gold Standard Registry.
What might we do that would achieve this end?