Using Insights from End-of-Life Care Survey to Drive Improvement of Care at the End of Life


Margaret C Wang, PhD, MPH; Diane Brown, PhD, RN, FNAHQ, FAAN;
Peter S Khang, MD; Ruma Kumar, MD

Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Colorado, Georgia, Hawaii, Northern California, Northwest, Southern California, Washington, Program Office

Background: Patient-centeredness, a key aspect of high-quality health care, is especially important among patients with advanced illness. However, there are very few measures available to enable consistent assessment of a patient’s care experience across various care settings at the end of life. To address this knowledge gap and Kaiser Permanente (KP) organizational need, we developed, field-tested, and implemented a 21-question survey administered to deceased members’ next of kin in 7 KP Regions, including KP Northern California, KP Southern California, KP Colorado, KP Georgia, KP Hawaii, KP Northwest, and KP Washington.
Methods: Survey respondents included the next of kin of recently deceased KP members who were age 18 years or older. Some of the deceased members received various forms of supportive services (eg, palliative care, hospice care, or both). Survey results were compared between those who received supportive services and those who did not, and across other factors of interest. Primary outcomes were: 1) overall rating of end-of-life quality, adopted from Veterans Administration’s Bereaved Family Survey and endorsed by National Quality Forum; 2) KP providing care that met members’ wishes; and 3) physicians and staff including members’ preferences when discussing treatment options and care plans.
Results: There were 2701 surveys completed (25.6% response rate). Respondents were close family members (81.8%); familiar with the decedents’ health issues (92%) and discussed end-of-life care preferences with them (87%). Overall care in the last month of life was rated “Excellent” or “Very Good” by 80% of respondents. Respondents for members who received supportive services were more likely to rate care “Excellent” or “Very Good” (82%), compared with those who did not (69%). Care experience varied meaningfully across KP Regions (eg, overall care rating of “Excellent” or “Very Good” ranged from 74% to 84%). Regions are using the data to inform and validate strategic planning, implementation, and for further understanding (eg, drill down to service level or patient-specific circumstances) to enhance care for members at the end of life.
Discussion: The End-of-Life Care Survey provides KP’s first interregional patient-centered quality measure for this important and sensitive care. Insights are used to facilitate learning across Regions and to support leaders in Specialty Palliative Care and Life Care Planning initiatives to assess aspects of care aligned with Specialty Palliative Care and Life Care Planning and to better understand the relationship between program participation and care experience. Additional opportunities to leverage this rich data to improve end-of-life care should be explored (eg, analyzing data from open-ended comments to guide further focus group explorations, linking survey and clarity data to better understand the relationship between care delivery and care experience).

Abstracts from the Kaiser Permanente 2019 National Quality Conference


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