Challenges Of Measuring Quality Of Community-Based Programs For Seriously Ill Individuals And Their Families

Abstract

For many individuals and their families, acknowledging and confronting a serious illness such as cancer or advanced heart failure is a sentinel life event. From a health policy perspective, many individuals confronting such illnesses are high-need, high-cost patients who are increasingly cared for by community-based programs that may have competing goals: improving quality and reducing costs. Providing care to high-need, high-cost patients tests a health care system's ability to coordinate care and adapt to highly variable disease trajectories that could result in improved health for some, sudden and unexpected death for others, and a prolonged period of functional impairment for the majority. With the rapid growth in the number of community-based programs, efforts are needed to ensure transparency and accountability for this vulnerable population. In this article we outline the challenges in measuring quality of care for seriously ill patients, offer potential solutions, and call for new research to produce quality measures that ensure accountability for the care provided to seriously ill individuals and their families.

Using Electronic Health Records for Quality Measurement and Accountability in Care of the Seriously Ill: Opportunities and Challenges

“…As such, it offers a repository with sufficient size and scope to support analyses of detailed clinical care and assessments of important subgroups of patients, such as those with serious illness, including ''high-cost, high-need'' patients who particularly benefit from palliative care. 13,[21][22][23] In addition, EHR data are recorded directly from documentation of healthcare delivery and utilization without requiring additional data entry beyond that accompanying routine care. The EHR also captures social determinants of health, which are important to the delivery of high-quality, accountable care for the seriously ill. 24 Alongside these strengths, the EHR has important limitations.…”

“…10 There is also increasing interest in ensuring highquality, population-based care for seriously ill patients and their families across settings, including hospital, clinical, longterm care facility, and home, and using quality measurement to ensure accountability for this care. [11][12][13] In this context, it is critical that we develop and validate quality metrics that facilitate implementation and evaluation of clinical and policy programs that improve palliative care and enhance accountability for serious illness care across diverse settings.…”

Quality Measurement of Serious Illness Communication: Recommendations for Health Systems Based on Findings from a Symposium of National Experts

“…Experts have begun to articulate and address the challenges inherent to providing and measuring quality care for seriously ill persons and their families, among them, assessing high-quality communication. 20,21 The absence, underdevelopment, or limited applicability of quality measures related specifically to SIC, and their limited application only to those seen by specialist palliative and hospice care teams, hinder efforts to improve care planning, service delivery, and health outcomes for all seriously ill patients. SIC warrants distinction as a focus of quality measurement due to (1) the risk of suffering in serious illness, (2) the potential for communication to mitigate this suffering, and (3) the unique implementation challenges inherent to such communication, including clinician avoidance due to training deficits and difficult emotions.…”

Sociological Modeling of Smart City with the implementation of UN Sustainable Development Goals

“…Modern health policy aims to create community-based programs and foster a culture of health in society (Acosta et al 2016;Plough et al 2018;Teno et al 2017). It is time to rethink past approaches and construct smart cities in order to reduce morbidity and mortality rates for the next decades by digital urban infrastructure.…”