Quality indicators for assessment of palliative care provision in New Zealand Roshan Perera and Helen Moriarty

1. 1
Quality Indicators for
Assessment of Palliative
Care provision in NZ
Dr Roshan Perera and Dr Helen Moriarty
University of Otago Wellington.
29 October 2014 Roshan Perera HNZ presentation

2. Overview
The ImPaCT project
The Indicator “Suites”
Future plans
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3. The ImPaCT project
TOH: planned evolution of an integrated model
of care provision
Action research project for evaluation of
process change and impact on quality of care
• Qualitative and quantitative arms for
empirical research
• Output incl: 40 Quality measures within 6
suites of indicators for PC quality
assessment
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4. ‘Ground-up’ approach
 Point of difference
• Empirical data for indicator selection not always
readily available
• Often top-down approaches, using expert consensus
• Research had explicit intention of identifying areas
suitable for indicator development
 Relevance: addresses areas identified as
important by stakeholders
 Engages field workers and end-users
 Stakeholder ownership and confidence
• Measure what matters
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5.  Builds on existing quality efforts
 Purposively constructed
 Take into account the feasibility of routine data
collection and collation in community settings
 Fit for purpose
 Organised and linked ‘functionally’ rather than
theoretically
 Applicable for assessment of quality of care
provision across a variety of settings
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6. Indicator development
Empirical research from ImPacT project
highlighted challenges to integrated
community-based palliative care provision
• Confidence and Competence (includes scope of
generalist vs specialist care and timing of transition)
• Workload, time constraints and responsiveness
• Continuity of care; communication and reporting
• Access to resources, equipment, support services
• Capacity building and education
• Organisational change
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7. Indicator development
 Topic areas and indicators derived from the
identified challenges
• Effective care
• Timely access to health care
• Communication
• Continuity of care and access to support services and
equipment
• Responsiveness to family/carer needs
• Education and capacity
 Numerators/Denominators and caveats
specified
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8. A greater truth?
 Quality issues consistent with the international literature
• Improved communication and capacity building
• Clear definition of roles/responsibilities/lines of reporting
• Tech skills and holistic care
• Ready access to specialist PC
 Consistent with the consensus indicators and outcome
measures developed by other means
 Synergy in topic areas across the various approaches
taken – potentially suggests a ‘greater truth’ evident
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9. Why indicator “suites”
Indicators focus on discrete areas (pin-pricks
of light)
Clusters of related indicators provide a
wider beam of illumination onto a
particular aspect of care
Enables comprehensive review of the
aspect of care in question
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11. Topic areas
for the indicator suites
 Effective Care
 Timely access
Communication
 Continuity of care; community support and
support services
 Responsiveness to family /carer needs
 Education and capacity
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12. The Indicators
 Suite 1: Effective care
• Clinical symptom control and assessment
• Review of symptom control
• Clinical management documentation
 Suite 2: Timely access to health care
• Service availability and response to office/practice,
home visit requests, phone calls and after-hours
contact
• Service availability and response to requests for
prescriptions, referral, social support, equipment and
certification
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13.  Suite 3: Communication
• Documentation of communication and decisions
within team, with patient/carer, and external services
(incl GP)
 Suite 4: Support for maintenance of continuity of
care; and for accessing support services
including social support and required equipment
• Documentation to enable access to necessary
services incl social support, external providers and
equipment
• Provision of complete and appropriate documentation
for certification
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14.  Suite 5: Responsiveness to family/carer needs
• Identification and review of needs
• Appropriate documentation and ability to track
responsiveness
• F/U and addressing of bereavement/family satisfaction
• Positive impact on the community (donations)
 Suite 6: Education and capacity
• Availability of an appropriately and highly skilled
workforce, and sufficient range of PC services to meet
need
(Id and resolution of workforce and service requirements,
and shortfalls; provision of education by locational
specialist workforce)
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16. Suite 5
Topic: Family Needs
Aspect of care: Responsiveness
 Addresses need for:
• Systems and processes which
• Identify family needs and bereavement support
• Flag need for bereavement support prior to 6 weeks
• Maintain accurate records
 Unit of analysis
• Individual practice or GP
• Rest home/ARC
• Hospice/specialist team
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17. Suite 5
 Denominator:
• Palliative care patients enrolled at a GP practice and
under Hospice or Rest Home care
 Numerators
Indicator 1:
• Documentation of family/carer needs at first contact
• Itemisation of identified needs at first contact
• Documentation of review of family/carer needs at (x
interval) including need for early bereavement support
• Documented action on identified needs
Indicator 2:
• Patient dies at negotiated place of death
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18. Numerators
Indicator 3:
Suite 5
• Bereavement support f/u at 6/52 documented
Indicator 4:
• Family satisfaction with service provision documented
• F/U within 2/52 of family issues with service provision
documented
Indicator 5:
• Donations to Hospice/Volunteer workforce
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19. So What?
 Comparison of care provision & benchmarking standards of care
across PC service delivery settings, to:
• Compare current care to aspirational statements
• Identify gaps in quality/ safety/ equity of access
• Investigate extent and impact of variability in PC service
provision
• Foster improvement initiatives and inform change
• Foster a quality culture: feasibility and benefits of routine use
 Pilot to gather data to enable target setting
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20. Future plans
ImPaCT project quantitative arm
GP survey
National benchmarking, effectiveness and
future national standard setting (HRC
grant application)
Sandpit meeting (2015)
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21. Discussion
What Indicators of Quality Service are currently
in use and how are they used?
What are the barriers to routine use?
• Eg for routine audit and QA/QI purposes
• GP survey : what should we ask them? Any
feedback on intended questions?
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22. An exercise for you to do:
 In small groups
 Each discuss a recent bereavement episode that
you were involved with
 Identify care aspects that might have gone
differently if an “early warning” or quality
indicator were routinely in place.
 What would the warning/indicator have been?
 What aspect of service would have been
impacted?
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23. Acknowledgements
 Te Omanga Hospice – staff, volunteers,
patients/carers, GPs, Trustees/Board
 Hospice New Zealand
 Palliative Care Council
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