Improving Palliative Care for Cancer

TABLE 3-1 Purposes of Quality Measures

Purpose	Description
Quality improvement	Measures to provide information for health care institutions to reform or shape how care is provided
Clinical assessment	Measures to guide individual patient management
Research	Measures that assess the phenomenon of interest
Accountability	Measures that allow comparison of quality of care for the purposes of quality assurance or for consumer choice between health care institutions or practitioners
SOURCE: Teno et al., 1999.

TABLE 3-2 Areas of Emphasis Based on the Purpose of Quality Measure

	Purpose of Measure
	Clinical Assessment	Research	Improvement	Accountability
Audience	Clinical staff	Science community	QI team and clinical staff	Payers, public
Focus of measurement	Status of patient	Knowledge	Understand care process	Comparison
Confidentiality	Very high	Very high	Very high	Low
Evidence base to justify use of measure	Important; measure should have face validity from a clinical standpoint	Builds on existing evidence to generate new knowledge	Important	Extremely important in that proposed domain ought to be under control of the institution
Importance of psychometric properties	Important to individual provider	Extremely important to the research effort	Important within specific setting	Valid and responsive across multiple settings
SOURCE: Adapted from Solberg et al. (1997) and Teno et al. (1999).

tions of the use of measurement tools, more stringent psychometric properties than are now employed must be put into measures that will be used for public accountability. In addition, there must be either normative or empirical research substantiating a claim that the construct being measured for public accountability is under the control of the health care institution.

Table of Contents

Front Matter R1-R18

Part 1: Executive Summary 1-8

1 Background and Recommendations 9-64

Part 2 2 Reliable, High-Quality, Efficient End-of-Life Care for Cancer Patients: Economic Issues and Barriers 65-95

3 Quality of Care and Quality Indicators for End-of-Life Cancer Care: Hope for the Best, Yet Prepare for the Worst 96-131

4 The Current State of Patient and Family Information About End-Of-Life Care 132-152

5 Palliative Care for African Americans and Other Vulnerable Populations: Access and Quality Issues 153-160

6 End-of-Life Care: Special Issues in Pediatric Oncology 161-198

7 Clinical Practice Guidelines for the Management of Psychosocial and Physical Symptoms of Cancer 199-232

8 Cross-Cutting Research Issues: A Research Agenda for Reducing Distress of Patients With Cancer 233-276

9 Professional Education in Palliative and End-of-Life Care for Physicians, Nurses, and Social Workers 277-310

Index 311-325