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Next Reply: Re:Quality Metrics Reporting, QNET
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Post Quality Metrics Reporting, QNET
Author: rsawicki
Date: May 17, 2011 11:07 am
It has come to our attention that if a patient in our hospitals has a palliative care consult ordered, our quality reporting service...QNET...automatically removes them from the measures, considering them to be "comfort care only". Clearly this is a misperception, which we all deal with regularly, and we are trying to correct their knowledge base without much success. Our hospital quality folks are concerned about having all palliative patients removed from the pool, and the impact that will have on our scores. One can argue the effect, but to me, the larger question is, have any of you out there run in to this, and have you resolved it? Thanks,
Bob
Replies: order by [Date] [Author] [Subject]
Re:Quality Metrics Reporting, QNET (by ultrapollo08 on 05/17/2011)
With meaningful use, we have a specific order entry that I enter after screening the patient. This separates the EOL/hospice encounter from the pain management patients. We use Meditech and order entry and this manual approach has been successful
Re:Quality Metrics Reporting, QNET (by rsawicki on 05/18/2011)
The issue we have is that our palliative service is not just a pain service. It is comprehensive, and not just end of life or hospice. It is difficult to believe that the reviewers cannot recognize the difference between "comfort care only" patients, and those who need excellent symptom management, coordination of care, and all the other things our teams are doing. I am not sure an order would solve this question completely, but it bears some looking in to.
Re:Quality Metrics Reporting, QNET (by DrJoanneLynn on 05/18/2011)
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?
Re:Quality Metrics Reporting, QNET (by DrJoanneLynn on 05/18/2011)
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?
Re:Quality Metrics Reporting, QNET (by DrJoanneLynn on 05/18/2011)
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?
Re:Quality Metrics Reporting, QNET (by DrJoanneLynn on 05/18/2011)
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?
Re:Quality Metrics Reporting, QNET (by rsawicki on 05/18/2011)
Dr. Lynn, that is an excellent point. The opposite, however, should also be true: we need to find a way to include those with serious, chronic-progressive, and/or fatal illness in measures of symptom management, readmission reduction, etc. What I am being told is that the exclusion of very sick patients (in my example, it is heart failure patients) in the quality measures is actually leading some to discourage using a formal palliative care team in order to keep them in the denominator. One can argue whether they would somehow be able to achieve the same outcomes, but as you have so well advocated, we need to be moving palliative care upstream so that the patients are seen much earlier in their trajectories, before exclusion would be appropriate. I apologize that I do not have an answer for your question of how to accommodate both sides of this. If I hear of one, I certainly will be passing it on!

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