Improving Serious Illness Care for Surgical Patients: Quality Indicators for Surgical Palliative Care.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 01 2022
01 01 2022
Historique:
pubmed:
6
6
2020
medline:
27
1
2022
entrez:
6
6
2020
Statut:
ppublish
Résumé
Develop quality indicators that measure access to and the quality of primary PC delivered to seriously ill surgical patients. PC for seriously ill surgical patients, including aligning treatments with patients' goals and managing symptoms, is associated with improved patient-oriented outcomes and decreased healthcare utilization. However, efforts to integrate PC alongside restorative surgical care are limited by a lack of surgical quality indicators to evaluate primary PC delivery. We developed a set of 27 preliminary indicators that measured palliative processes of care across the surgical episode, including goals of care, decision-making, symptom assessment, and issues related to palliative surgery. Then using the RAND-UCLA Appropriateness method, a 12-member expert advisory panel rated the validity (primary outcome) and feasibility of each indicator twice: (1) remotely and (2) after an in-person moderated discussion. After 2 rounds of rating, 24 indicators were rated as valid, covering the preoperative evaluation (9 indicators), immediate preoperative readiness (2 indicators), intraoperative (1 indicator), postoperative (8 indicators), and end of life (4 indicators) phases of surgical care. This set of quality indicators provides a comprehensive set of process measures that possess the potential to measure high quality PC for seriously ill surgical patients throughout the surgical episode.
Sections du résumé
OBJECTIVE
Develop quality indicators that measure access to and the quality of primary PC delivered to seriously ill surgical patients.
SUMMARY OF BACKGROUND DATA
PC for seriously ill surgical patients, including aligning treatments with patients' goals and managing symptoms, is associated with improved patient-oriented outcomes and decreased healthcare utilization. However, efforts to integrate PC alongside restorative surgical care are limited by a lack of surgical quality indicators to evaluate primary PC delivery.
METHODS
We developed a set of 27 preliminary indicators that measured palliative processes of care across the surgical episode, including goals of care, decision-making, symptom assessment, and issues related to palliative surgery. Then using the RAND-UCLA Appropriateness method, a 12-member expert advisory panel rated the validity (primary outcome) and feasibility of each indicator twice: (1) remotely and (2) after an in-person moderated discussion.
RESULTS
After 2 rounds of rating, 24 indicators were rated as valid, covering the preoperative evaluation (9 indicators), immediate preoperative readiness (2 indicators), intraoperative (1 indicator), postoperative (8 indicators), and end of life (4 indicators) phases of surgical care.
CONCLUSIONS
This set of quality indicators provides a comprehensive set of process measures that possess the potential to measure high quality PC for seriously ill surgical patients throughout the surgical episode.
Identifiants
pubmed: 32502076
pii: 00000658-202201000-00029
doi: 10.1097/SLA.0000000000003894
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
196-202Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. 4th editionNational Coalition for Hospice and Palliative Care: Richmond, VA; 2018.
Kelley AS. Defining “serious illness”. J Palliat Med 2014; 17:985.
Schneider E, Abrams M, Shah A, et al. Health Care in America: The Experience of People with Serious Illness 2018. Available at: https://www.commonwealthfund.org/sites/default/files/2018-10/Schneider_HealthCareinAmerica.pdf . Accessed September 19, 2019
Quill TE, Abernethy AP. Generalist plus specialist palliative care--creating a more sustainable model. N Engl J Med 2013; 368:1173–1175.
Lilley EJ, Khan KT, Johnston FM, et al. Palliative care interventions for surgical patients: a systematic review. JAMA Surg 2016; 151:172–183.
Badgwell BD, Aloia TA, Garrett J, et al. Indicators of symptom improvement and survival in inpatients with advanced cancer undergoing palliative surgical consultation. J Surg Oncol 2013; 107:367–371.
Lilley EJ, Cooper Z, Schwarze ML, et al. Palliative care in surgery: defining the research priorities. J Palliat Med 2017; 20:702–709.
Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q 1966; 44:166–206.
National Quality Forum. Measure Evaluation Criteria 2019. http://www.qualityforum.org/Measuring_Performance/Submitting_Standards/Measure_Evaluation_Criteria.aspx , Accessed January 8, 2019
Zingmond DS, Ettner SL, Wilber KH, et al. Association of claims-based quality of care measures with outcomes among community-dwelling vulnerable elders. Med Care 2011; 49:553–559.
Higashi T, Shekelle PG, Adams JL, et al. Quality of care is associated with survival in vulnerable older patients. Ann Intern Med 2005; 143:274–281.
Arora VM, Fish M, Basu A, et al. Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality. J Am Geriatr Soc 2010; 58:1642–1648.
Kahn KL, Tisnado DM, Adams JL, et al. Does ambulatory process of care predict health-related quality of life outcomes for patients with chronic disease? Health Serv Res 2007; 42:63–83.
Shahian DM. Professional society leadership in health care quality: the society of thoracic surgeons experience. Jt Comm J Qual Patient Saf 2019; 45:466–479.
McGory ML, Kao KK, Shekelle PG, et al. Developing quality indicators for elderly surgical patients. Ann Surg 2009; 250:338–347.
Agency for Healthcare Research and Quality. Inpatient Quality Indicators 2018. Available at: https://www.qualityindicators.ahrq.gov/Modules/all_resources.aspx . Accessed June 11, 2019
Stelfox HT, Bobranska-Artiuch B, Nathens A, et al. Quality indicators for evaluating trauma care: a scoping review. Arch Surg 2010; 145:286–295.
Stelfox HT, Straus SE, Nathens A, et al. Evidence for quality indicators to evaluate adult trauma care: a systematic review. Crit Care Med 2011; 39:846–859.
Maggard MA, McGory ML, Shekelle PG, et al. Quality indicators in bariatric surgery: improving quality of care. Surg Obes Relat Dis 2006; 2:423–429. discussion 429–430.
Clancy CM. SCIP: making complications of surgery the exception rather than the rule. Aorn J 2008; 87:621–624.
Bratzler DW, Hunt DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis 2006; 43:322–330.
American College of Surgeons. Commission on Cancer Quality of Care Measures Nov 30, 2018. Available at: https://www.facs.org/quality-programs/cancer/ncdb/qualitymeasures . Accessed June 11, 2019.
Fitch K, Fitch K, Bernstein SJ, et al. The RAND/UCLA Appropriateness Method User's Manual. Los Angeles, CA: RAND Corporation; 2001.
Walling A M, Ahluwalia S C, Wenger N S, et al. Palliative care quality indicators for patients with end-stage liver disease due to cirrhosis. Dig Dis Sci 2017; 62:84–92.
Shekelle P. The appropriateness method. Med Decis Making 2004; 24:228–231.
Shekelle PG, MacLean CH, Morton SC, et al. Assessing care of vulnerable elders: methods for developing quality indicators. Ann Intern Med 2001; 135 (8 Pt 2):647–652.
Dy SM, Kiley KB, Ast K, et al. Measuring what matters: top-ranked quality indicators for hospice and palliative care from the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association. J Pain Symptom Manage 2015; 49:773–781.
Lanken PN, Terry PB, Delisser HM, et al. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med 2008; 177:912–927.
American College of Surgeons. Optimal Resources for Surgical Quality and Safety. Chicago, IL: American College of Surgeons; 2017.
Lee KC, Walling AM, Senglaub SS, et al. Defining serious illness among adult surgical patients. J Pain Symptom Manage 2019; 58:844–850.e2.
American College of Surgeons Task Force on Surgical Palliative Care and Committee on Ethics. Statement of principles of palliative care. Bull Am Coll Surg 2005; 90:34–35.
American College of Surgeons Trauma Quality Improvement Program. ACS TQIP Palliative Care Best Practice Guidelines. Journal [serial online]. 2018. Available from: American College of Surgeons, Chicago, IL. Accessed June 1, 2018
ACS Commission on Cancer. Cancer Program Standards (2016 Edition) 2016. Available at: https://www.facs.org/∼/media/files/quality%20programs/cancer/coc/programstandards2012.ashx . Accessed Dec 18, 2018
Lorenz KA, Rosenfeld K, Wenger N. Quality indicators for palliative and end-of-life care in vulnerable elders. J Am Geriatr Soc 2007; 55 Suppl 2:S318–S326.
Mularski RA, Curtis JR, Billings JA, et al. Proposed quality measures for palliative care in the critically ill: a consensus from the Robert Wood Johnson Foundation Critical Care Workgroup. Crit Care Med 2006; 34: (11 Suppl): S404–S411.
Nelson JE, Puntillo KA, Pronovost PJ, et al. In their own words: patients and families define high-quality palliative care in the intensive care unit. Crit Care Med 2010; 38:808–818.
National Quality Forum. National Voluntary Consensus Standards: Palliative Care and End-of-Life Care–A Consensus Report 2012. Available at: http://www.qualityforum.org/Publications/2012/04/Palliative_Care_and_End-of-Life_Care%E2%80%94A_Consensus_Report.aspx . Accessed Nov 5, 2018
Berian JR, Rosenthal RA, Baker TL, et al. Hospital standards to promote optimal surgical care of the older adult: a report from the coalition for quality in geriatric surgery. Ann Surg 2017; 2:280–290.
Cooper Z, Corso K, Bernacki R, et al. Conversations about treatment preferences before high-risk surgery: a pilot study in the preoperative testing center. J Palliat Med 2014; 17:701–707.
Krouse RS, Nelson RA, Farrell BR, et al. Surgical palliation at a cancer center: incidence and outcomes. Arch Surg 2001; 136:773–778.
McCahill LE, Krouse R, Chu D, et al. Indications and use of palliative surgery-results of Society of Surgical Oncology survey. Ann Surg Oncol 2002; 9:104–112.
McCahill LE, Dunn GP, Mosenthal AC, et al. Palliation as a core surgical principle: part 1. J Am Coll Surg 2004; 199:149–160.
Taylor SM, Kalbaugh CA, Blackhurst DW, et al. Preoperative clinical factors predict postoperative functional outcomes after major lower limb amputation: an analysis of 553 consecutive patients. J Vasc Surg 2005; 42:227–235.
Rankin T, Mailey B, Suliman A, et al. Palliative reconstructive surgery may improve quality of life in high functioning noncurable head and neck oncologic patients. Ann Plast Surg 2015; 74 Suppl 1:S52–S56.
Vidri RJ, Blakely AM, Kulkarni SS, et al. American College of Surgeons National Surgical Quality Improvement Program as a quality-measurement tool for advanced cancer patients. Ann Palliat Med 2015; 4:200–206.
Badgwell B, Krouse R, Klimberg SV, et al. Outcome measures other than morbidity and mortality for patients with incurable cancer and gastrointestinal obstruction. J Palliat Med 2014; 17:18–26.
Schwarze ML, Brasel KJ, Mosenthal AC. Beyond 30-day mortality: aligning surgical quality with outcomes that patients value. JAMA Surg 2014; 149:631–632.
Chan A, Chien I, Moseley E, et al. Deep learning algorithms to identify documentation of serious illness conversations during intensive care unit admissions. Palliat Med 2019; 33:187–196.
Forsyth AW, Barzilay R, Hughes KS, et al. Machine learning methods to extract documentation of breast cancer symptoms from electronic health records. J Pain Symptom Manage 2018; 55:1492–1499.
Lilley EJ, Lindvall C, Lillemoe KD, et al. Measuring processes of care in palliative surgery: a novel approach using natural language processing. Ann Surg 2018; 267:823–825.
Lindvall C, Lilley EJ, Zupanc SN, et al. Natural language processing to assess end-of-life quality indicators in cancer patients receiving palliative surgery. J Palliat Med 2019; 22:183–187.
Suwanabol PA, Kanters AE, Reichstein AC, et al. Characterizing the role of U.S. surgeons in the provision of palliative care: a systematic review and mixed-methods meta-synthesis. J Pain Symptom Manage 2018; 55:1196–1215.e5.
Bakke KE, Miranda SP, Castillo-Angeles M, et al. Training surgeons and anesthesiologists to facilitate end-of-life conversations with patients and families: a systematic review of existing educational models. J Surg Educ 2018; 75:702–721.
Miyashita M, Morita T, Ichikawa T, et al. Quality indicators of end-of-life cancer care from the bereaved family members’ perspective in Japan. J Pain Symptom Manage 2009; 37:1019–1026.