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

Abstract

Background: Communication between clinicians and patients fundamentally shapes the experience of serious illness. There is increasing recognition that health systems should routinely implement structures and processes to assure high-quality serious illness communication (SIC) and measure the effectiveness of their efforts on key outcomes. 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. Objective: We convened an expert stakeholder symposium and subsequently surveyed participants to consider challenges, opportunities, priorities, and strategies to improve quality measurement specific to SIC. Results: We identified several barriers and opportunities to improving quality measurement of SIC. These include issues related to the definition of SIC, methodological challenges related to measuring SIC and related outcomes, underutilization of technologies that can facilitate measurement, and measurement development, and dissemination. Conclusions: Patients, clinicians, and health systems increasingly align around the importance of highquality communication in serious illness. We offer recommendations for various stakeholder groups to advance SIC quality measurement. Enthusiasm and a sense of urgency among health systems to drive and measure communication improvements inform our proposal for a set of example measures for implementation now.

Development and Validation of a 30-Day In-hospital Mortality Model Among Seriously Ill Transferred Patients: a Retrospective Cohort Study

“…Our model has several potential implications for interventions in patients with serious illness, including identification of high-risk patients for additional clinical review and as a possible trigger for SIC. 12 According to a recent national experts' consensus, EMR should reduce the burden of data capture on clinicians and hospital systems by meaningful communication of SIC 12 ; the present model could be used for this purpose. A real-time mortality predicting EWS was prospectively validated to predict patients at high risk for inpatient mortality using machine learning methods and identified 40% of patients 24 to 48 h before their death but only 11% of patients 3 to 7 days before death.…”

“…2,4 Despite its recognized value, SIC are often delayed towards the end of the disease trajectory after exhausting all life-sustaining treatments leading to patient and family dissatisfaction and under-utilization of palliative care and hospice services. 4,11,12 Recognizing these complexities clinicians have expressed an interest in adopting evidencebased clinical prediction models to increase their prognostic confidence in the end-of-life care. 13 Available models predicting mortality are often limited to ICU settings, 14 are condition-specific, [15][16][17][18] or predict deaths after hospital discharge.…”

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

“…[201][202][203] Healthcare providers now see the importance of initiating advance care planning with patients, especially for those with severe chronic diseases. 204 Policies and protocols to facilitate advance care planning communication have been developed and are being increasingly adopted. 89 The literature indicates that advance care planning discussions should be integrated into various areas of the healthcare system, such as primary and emergency care, preoperative settings, and intensive care units.…”

A Novel Patient Values Tab for the Electronic Health Record: A User-Centered Design Approach (Preprint)

“…Our early pilot data have also revealed potential barriers to large-scale implementation, which include perceived lack of time to engage with the tab, competing priorities, incomplete or inaccurate tab content, technical glitches, and difficulty remembering to launch the tab as part of routine workflow. To address these challenges, we have enacted several proactive educational strategies when deploying to additional user groups, including (1) emphasizing that the tab is a display-only feature that is intended to save time by consolidating key information in a central location, (2) describing the processes by which incomplete or inaccurate tab content can be updated by the user, and (3) highlighting the "share feedback" section as a means for providing feedback on technical (or content-related) glitches that can be addressed by the Patient Values Tab interdisciplinary working group. In all circumstances, the Patient Values Tab working group follows up with each individual user who provides feedback to ensure closed-loop communication and enhance transparency in the ongoing effort to refine and optimize the tab's functionality.…”