Claire E O'Hanlon1, Karleen F Giannitrapani2,3, Charlotta Lindvall4,5, Raziel C Gamboa2, Mark Canning6, Steven M Asch2,3, Melissa M Garrido7,8, Anne M Walling6,9, Karl A Lorenz2,3. 1. Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA. Claire.O'Hanlon@va.gov. 2. Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA. 3. Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA. 4. Department of Psychosocial Oncology and Palliative Care (POPC), Dana-Farber Cancer Institute, Boston, MA, USA. 5. Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. 6. Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA. 7. Partnered Evidence-Based Policy Resource Center (PEPReC), VA Boston Healthcare System Research & Development, Boston, MA, USA. 8. Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, USA. 9. Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA.
Abstract
BACKGROUND: Development and prioritization of quality measures typically relies on experts in clinical medicine, but patients and their caregivers may have different perspectives on quality measurement priorities. OBJECTIVE: To inform priorities for health system implementation of palliative cancer and end-of-life care quality measures by eliciting perspectives of patients and caregivers. DESIGN: Using modified RAND-UCLA Appropriateness Panel methods and materials tailored for knowledgeable lay participants, we convened a panel to rate cancer palliative care process quality measure concepts before and after a 1-day, in-person meeting. PARTICIPANTS: Nine patients and caregivers with experience living with or caring for patients with cancer. MAIN MEASURES: Panelists rated each concept on importance for providing patient- and family-centered care on a nine-point scale and each panelist nominated five highest priority measure concepts ("top 5"). KEY RESULTS: Cancer patient and caregiver panelists rated all measure concepts presented as highly important to patient- and family- centered care (median rating ≥ 7) in pre-panel (mean rating range, 6.9-8.8) and post-panel ratings (mean rating range, 7.2-8.9). Forced choice nominations of the "top 5" helped distinguish similarly rated measure concepts. Measure concepts nominated into the "top 5" by three or more panelists included two measure concepts of communication (goals of care discussions and discussion of prognosis), one measure concept on providing comprehensive assessments of patients, and three on symptoms including pain management plans, improvement in pain, and depression management plans. Patients and caregivers nominated one additional measure concept (pain screening) back into consideration, bringing the total number of measure concepts under consideration to 21. CONCLUSIONS: Input from cancer patients and caregivers helped identify quality measurement priorities for health system implementation. Forced choice nominations were useful to discriminate concepts with the highest perceived importance. Our approach serves as a model for incorporating patient and caregiver priorities in quality measure development and implementation.
BACKGROUND: Development and prioritization of quality measures typically relies on experts in clinical medicine, but patients and their caregivers may have different perspectives on quality measurement priorities. OBJECTIVE: To inform priorities for health system implementation of palliative cancer and end-of-life care quality measures by eliciting perspectives of patients and caregivers. DESIGN: Using modified RAND-UCLA Appropriateness Panel methods and materials tailored for knowledgeable lay participants, we convened a panel to rate cancer palliative care process quality measure concepts before and after a 1-day, in-person meeting. PARTICIPANTS: Nine patients and caregivers with experience living with or caring for patients with cancer. MAIN MEASURES: Panelists rated each concept on importance for providing patient- and family-centered care on a nine-point scale and each panelist nominated five highest priority measure concepts ("top 5"). KEY RESULTS: Cancer patient and caregiver panelists rated all measure concepts presented as highly important to patient- and family- centered care (median rating ≥ 7) in pre-panel (mean rating range, 6.9-8.8) and post-panel ratings (mean rating range, 7.2-8.9). Forced choice nominations of the "top 5" helped distinguish similarly rated measure concepts. Measure concepts nominated into the "top 5" by three or more panelists included two measure concepts of communication (goals of care discussions and discussion of prognosis), one measure concept on providing comprehensive assessments of patients, and three on symptoms including pain management plans, improvement in pain, and depression management plans. Patients and caregivers nominated one additional measure concept (pain screening) back into consideration, bringing the total number of measure concepts under consideration to 21. CONCLUSIONS: Input from cancer patients and caregivers helped identify quality measurement priorities for health system implementation. Forced choice nominations were useful to discriminate concepts with the highest perceived importance. Our approach serves as a model for incorporating patient and caregiver priorities in quality measure development and implementation.
Authors: Elvira M E den Breejen; Rosella P M G Hermens; Wienke H Galama; Wim N P Willemsen; Jan A M Kremer; Willianne L D M Nelen Journal: Int J Qual Health Care Date: 2016-03-10 Impact factor: 2.038
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Authors: Stefanie N Hofstede; Leti van Bodegom-Vos; Manon M Wentink; Carmen L A Vleggeert-Lankamp; Thea P M Vliet Vlieland; Perla J Marang-van de Mheen Journal: PLoS One Date: 2014-04-07 Impact factor: 3.240