Determining Community Provider Practices in Hospices: The Challenges of Documentation.

Documentation is a key factor in supporting consistency and quality of patient care in the hospice setting, however variation among program provider practices, including documentation, were observed during the initial data collection phase of our National Cancer Institute (NCI) funded study, Cancer Pain in Elders: Promoting Evidence-Based Practices (EBPs) in Hospices. The study is a randomized trial to test a multifaceted intervention to promote adoption and maintenance of EBPs for cancer pain management involving 16 Midwestern hospices of varied size and structure. In the face of such variance, and especially in the absence of uniformly adopted outcome measures and documentation standards, quality improvement initiatives in this important and growing healthcare sector will be difficult to manage. This paper provides background on the importance of documentation, quality measures, outcomes of care, and regulatory imperatives in the hospice setting with specific observations from our research study and suggestions for changes in documentation practices.From our observations, we posit the necessity of pertinent outcome measures supported by standardized documentation processes in hospice. Uniformity in key practice indicators and patient outcome measures in documentation systems would advance the movement to improve quality and consistency of care in hospices. Standardization of documentation systems and language would also facilitate the conduct of research in the hospice setting, a population for which advancing knowledge is essential to assure quality care at the end of life.