Quality, Palliative Care, CredentialingPalliative care, one of the more emotionally charged areas of healthcare, opens organizations to a wide variety of risks as care is complicated by the many disciplines involved in the coordination of care. Palliative care (from Latin palliare, to cloak) is care focused on relieving and preventing the suffering of patients. This broad approach allows the palliative care team to address physical, emotional, spiritual, and social concerns that arise with long term or advanced illness.

Despite the increased need and public demand for enhanced care for the elderly and those with life-threatening illness, most healthcare professionals have limited formal education in geriatrics and palliative care. Moreover, formal education in interdisciplinary team training has been limited at best. Proactive measures should be initiated to enhance education and training in palliative care, to embed best practices and protocols in the training of physicians, nurses, social workers, as well as other associated health team members.

Family members managing the emotional stress of caring for loved ones during end of life care are especially sensitive to events or incidents. To better protect your organization, it’s imperative to validate your team’s credentials are managed appropriately and ensure all events are reported and recorded as the potential for litigation is heightened.

Adding to the complexities of delivering healthcare from a disparate group of practitioners is the need to compile the same information and make it accessible to each person providing care. Without an accessible and flexible system it’s nearly impossible for all involved to have all the information necessary to provide quality care to the patient.

Quality of care is crucial as palliative care requires standardized quality measures be tracked, trended and interpreted across organizations. Reporting of incidents and credentialing of the interdisciplinary team is critical to ensure standards are met and/or exceeded.

Quality health care for Medicare patients is a top priority for the Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS). Subsequently, CMS has adopted the mission of The Institute of Medicine (IOM), defining quality as having the following properties or domains:

  • Effectiveness: Relates to providing care processes and achieving outcomes as supported by scientific evidence.

  • Efficiency: Maximizing the quality of a comparable unit of health care delivered or unit of health benefit achieved for a given unit of health care resources used.

  • Equity: Providing health care of equal quality to those who may differ in personal characteristics other than their clinical condition or preferences for care.

  • Patient Centeredness: Meeting patients' needs, preferences, providing education and support.

  • Safety: Relates to actual or potential bodily harm.

  • Timeliness: Obtaining needed care while minimizing delays.

Each property defined by the IOM stresses the importance of accurate, effective and reportable processes in managing Credentialing and Quality in Palliative Care.

Errors in medical care are discovered through a variety of mechanisms. Historically, medical errors have been revealed through morbidity and mortality committees as well as malpractice claims data. Prominent studies of medical error have used retrospective chart review to quantify adverse event rates. While the collection of data in this manner yields important epidemiologic information, it’s costly and provides little insight into potential error reduction strategies.

Moreover, chart review only detects documented adverse events and often does not capture information regarding their causes. Important errors that produce no injury can go completely undetected by this method. Systems for incident reporting, trending and tracking of errors can prevent and provide strategies for quality improvement that can & will effect meaningful change to patients today as opposed to the review historical data in six months or a year.

As our population extends the length of life expectancy, our healthcare system will be required to manage a larger volume of patients in need of palliative care. Equally important, our population becomes more knowledgeable as years pass, the quality metrics from FPPE/OPPE reporting, DHS, CMS and IOM will become more entrenched and publicized in the continuum of quality care. Embracing requirements, harnessing flexible software solutions and making them part of your organization’s best practices and standards will reduce risk, increase efficiencies and generate revenue all while delivering intuitive care to those, who in many cases, are our most sensitive patients, those in need of palliative care.


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