National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 138 Research Studies DisplayedKavalieratos D, Corbelli J, Zhang D
Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis.
This review sought to determine the association of palliative care with quality of life (QOL), symptom burden, survival, and other outcomes for people with life-limiting illness and for their caregivers. It concluded that the association between palliative care and QOL was attenuated but remained statistically significant whereas the association with symptom burden was not statistically significant . There was no association between palliative care and survival.
AHRQ-funded; HS022989.
Citation: Kavalieratos D, Corbelli J, Zhang D .
Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis.
JAMA 2016 Nov 22;316(20):2104-14. doi: 10.1001/jama.2016.16840.
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Keywords: Caregiving, Palliative Care, Quality of Life, Patient-Centered Outcomes Research
Hochman MJ, Kamal AH, Wolf SP
Anticholinergic drug burden in noncancer versus cancer patients near the end of life.
This article's objective is to determine anticholinergic load (ACL) and its impact in noncancer versus cancer palliative care patients. The authors concluded that ACL is associated with worse fatigue and quality of life and may not differ significantly between cancer and noncancer patients nearing end of life. Symptom management drugs are more responsible for ACL in cancer and noncancer patients, although disease management drugs contribute significantly to ACL in the latter group. They recommend more attention to reducing anticholinergic use in all patients with life-limiting illness.
AHRQ-funded; HS023681.
Citation: Hochman MJ, Kamal AH, Wolf SP .
Anticholinergic drug burden in noncancer versus cancer patients near the end of life.
J Pain Symptom Manage 2016 Nov;52(5):737-43.e3. doi: 10.1016/j.jpainsymman.2016.03.020.
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Keywords: Adverse Drug Events (ADE), Cancer, Medication, Palliative Care, Quality of Life
Wang SY, Hall J, Pollack CE
Associations between end-of-life cancer care patterns and Medicare expenditures.
The authors examined the extent to which patterns of intensive end-of-life care explain geographic variation in end-of-life care expenditures among cancer decedents. The mean expenditure per cancer decedent in the last month of life was $10,800, with considerable variation in the percentage of decedents receiving intensive end-of-life care intervention. Regional patterns of late chemotherapy or late hospice use explained only approximately 1% of the expenditure difference, while the proportion of decedents who had ICU admissions within 30 days of death was a major driver of variation, explaining 37.6% of the expenditure difference. They concluded that promoting appropriate end-of-life care has the potential to reduce geographic variation in end-of-life care expenditures.
AHRQ-funded; HS023900.
Citation: Wang SY, Hall J, Pollack CE .
Associations between end-of-life cancer care patterns and Medicare expenditures.
J Natl Compr Canc Netw 2016 Aug;14(8):1001-8.
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Keywords: Cancer, Elderly, Healthcare Costs, Medicare, Palliative Care
Just E, Casarett DJ, Asch DA
Differences in terminal hospitalization care between U.S. men and women.
The authors sought to determine whether men and women receive different care during terminal hospitalizations by examining sex-based differences in lengths of stay, resuscitation status, and intensive interventions and processes of care. They found that. compared with men, women had slightly shorter hospitalizations and were more likely to have a do-not-resuscitate order. Women remained less likely to receive care in an intensive care unit, cardiopulmonary resuscitation, mechanical ventilation, hemodialysis, or surgical procedures. The researchers concluded that men who die in hospitals receive more aggressive care than women.
AHRQ-funded; HS018425.
Citation: Just E, Casarett DJ, Asch DA .
Differences in terminal hospitalization care between U.S. men and women.
J Pain Symptom Manage 2016 Aug;52(2):205-11. doi: 10.1016/j.jpainsymman.2016.01.013.
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Keywords: Disparities, Palliative Care, Hospitalization, Sex Factors, Elderly
Kavalieratos D, Rollman BL, Arnold RM
Homeward Bound, not hospital rebound: how transitional palliative care can reduce readmission.
Comment on a study concerning heart failure palliative care interventions.
AHRQ-funded; HS022989.
Citation: Kavalieratos D, Rollman BL, Arnold RM .
Homeward Bound, not hospital rebound: how transitional palliative care can reduce readmission.
Heart 2016 Jul 15;102(14):1079-80. doi: 10.1136/heartjnl-2016-309385.
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Keywords: Heart Disease and Health, Hospital Discharge, Hospital Readmissions, Palliative Care
Hochman MJ, Wolf S, Zafar SY
Comparing unmet needs to optimize quality: characterizing inpatient and outpatient palliative care populations.
The researchers compared the unmet needs of palliative care patients by location of care to better characterize these populations. They found that outpatients are more burdened by pain at first palliative care encounter compared to inpatients, yet outpatients experience higher quality of life and better performance status.
AHRQ-funded; HS023681.
Citation: Hochman MJ, Wolf S, Zafar SY .
Comparing unmet needs to optimize quality: characterizing inpatient and outpatient palliative care populations.
J Pain Symptom Manage 2016 Jun;51(6):1033-39.e3. doi: 10.1016/j.jpainsymman.2015.12.338.
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Keywords: Quality of Care, Inpatient Care, Ambulatory Care and Surgery, Palliative Care, Patient-Centered Outcomes Research
Kamal AH, Anderson WG, Boss RD
The Cambia Sojourns Scholars Leadership Program: project summaries from the inaugural scholar cohort.
The Cambia Health Foundation designed the Sojourns Scholar Leadership Program to facilitate leadership development among budding palliative care leaders. This paper presents the background, aims, and results to date of each of the projects from the scholars of the inaugural cohort.
AHRQ-funded; HS023681.
Citation: Kamal AH, Anderson WG, Boss RD .
The Cambia Sojourns Scholars Leadership Program: project summaries from the inaugural scholar cohort.
J Palliat Med 2016 Jun;19(6):591-600. doi: 10.1089/jpm.2016.0086.
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Keywords: Healthcare Delivery, Education: Continuing Medical Education, Palliative Care, Training
Wysham NG, Kamal AH
Integrating palliative care in the intensive care unit. evidence gaps and quality gaps.
The authors discuss Mularski and colleagues in the same issue, stating that this study provides an important advancement in measuring palliative care quality in the ICU. They commend Mularski and colleagues for advancing the candidate measures of ICU-based palliative care and conclude that this report draws attention to important and persistent deficiencies in comprehensive, patient-centered critical care delivery that needs to be addressed in research and in practice.
AHRQ-funded; HS023681.
Citation: Wysham NG, Kamal AH .
Integrating palliative care in the intensive care unit. evidence gaps and quality gaps.
Ann Am Thorac Soc 2016 May;13(5):595-7. doi: 10.1513/AnnalsATS.201601-061ED.
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Keywords: Evidence-Based Practice, Intensive Care Unit (ICU), Palliative Care, Patient-Centered Outcomes Research, Quality of Care
Kamal AH, Dionne-Odom JN
A Blue Ocean strategy for palliative care: focus on family caregivers.
The authors argue that there is an undeniable societal need (or high consumer value) for some entity to ensure that family caregivers stay healthy not only so they can provide the best care possible to patients, but also for their own sake. They believe palliative care should rise to meet this societal need and take on family caregivers as a new focus of its specialized care.
AHRQ-funded; HS023681.
Citation: Kamal AH, Dionne-Odom JN .
A Blue Ocean strategy for palliative care: focus on family caregivers.
J Pain Symptom Manage 2016 Mar;51(3):e1-3. doi: 10.1016/j.jpainsymman.2015.12.305.
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Keywords: Palliative Care, Caregiving, Quality of Life, Healthcare Delivery
Kamal AH, Bull J, Ritchie CS
Adherence to measuring what matters measures using point-of-care data collection across diverse clinical settings.
The purpose of this paper was to evaluate the implementation of Measuring What Matters (MWM) measures by exploring documentation of quality measure adherence across six diverse clinical settings inherent to palliative care practice. The authors found that the lowest adherence involved comprehensive assessments during the first visit in hospitalized patients in the intensive care unit and that the highest adherence across all settings involved documentation of management of moderate to severe pain. They recommended additional studies for better understanding of benchmarks and acceptable ranges for adherence tailored to various clinical settings.
AHRQ-funded; HS023681; HS022763.
Citation: Kamal AH, Bull J, Ritchie CS .
Adherence to measuring what matters measures using point-of-care data collection across diverse clinical settings.
J Pain Symptom Manage 2016 Mar;51(3):497-503. doi: 10.1016/j.jpainsymman.2015.12.313.
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Keywords: Quality Measures, Palliative Care, Patient-Centered Outcomes Research, Quality of Care, Patient Safety
Wang SY, Hall J, Pollack CE
Trends in end-of-life cancer care in the Medicare program.
The researchers sought to examine contemporary trends in end-of-life cancer care and geographic variation of end-of-life care aggressiveness among Medicare beneficiaries. They found that the proportion of beneficiaries receiving at least one potentially aggressive end-of-life intervention increased in repeated hospitalization, repeated ED visits, ICU admissions, and late hospice enrollment but declined in in-hospital death. End-of-life chemotherapy use did not change significantly over time. They concluded that despite growing focus on providing appropriate end-of-life care, there has not been an improvement in aggressive end-of-life cancer care in the Medicare program.
AHRQ-funded; HS023900.
Citation: Wang SY, Hall J, Pollack CE .
Trends in end-of-life cancer care in the Medicare program.
J Geriatr Oncol 2016 Mar;7(2):116-25. doi: 10.1016/j.jgo.2015.11.007.
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Keywords: Cancer, Care Management, Elderly, Medicare, Palliative Care, Outcomes, Patient-Centered Outcomes Research, Practice Patterns
Dy SM, Herr K, Bernacki RE
Methodological research priorities in palliative care and hospice quality measurement.
The authors describe three key priorities: 1) defining the population of interest for palliative care quality indicators, 2) developing methods to measure quality from different data sources, and 3) conducting research to advance the development of patient/family-reported indicators. They apply these concepts to the key quality domain of advance care planning and address relevance to implementation of indicators in improving care in order to facilitate improved quality measurement across all populations with serious illness and care for patients and families.
AHRQ-funded; HS023681.
Citation: Dy SM, Herr K, Bernacki RE .
Methodological research priorities in palliative care and hospice quality measurement.
J Pain Symptom Manage 2016 Feb;51(2):155-62. doi: 10.1016/j.jpainsymman.2015.10.019.
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Keywords: Research Methodologies, Palliative Care, Quality Measures, Quality Indicators (QIs), Quality of Care
Dinan MA, Li Y, Zhang Y
Resource use in the last year of life among patients who died with versus of prostate cancer.
The researchers conducted a retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data of men with prostate cancer. Patients who died of prostate cancer rather than from other causes had more hospice and outpatient use, less inpatient and ICU use, and lower overall costs. Efforts to shift care toward outpatient settings might provide more efficient and judicious care for patients during the end of life.
AHRQ-funded; HS022189.
Citation: Dinan MA, Li Y, Zhang Y .
Resource use in the last year of life among patients who died with versus of prostate cancer.
Clin Genitourin Cancer 2016 Feb;14(1):28-37.e2. doi: 10.1016/j.clgc.2015.07.006.
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Keywords: Cancer, Cancer: Prostate Cancer, Healthcare Costs, Healthcare Utilization, Men's Health, Mortality, Palliative Care, Patient-Centered Outcomes Research
Thienprayoon R, Marks E, Funes M
Perceptions of the pediatric hospice experience among English- and Spanish-speaking families.
The objective of this study was to explore parental perspectives of the hospice experience in children with cancer, and to explore how race/ethnicity impacts this experience. Both English and Spanish speakers described the importance of honest, direct communication by medical providers, and anxieties surrounding the expectation of the moment of death. English-speaking families were more likely to return to the hospital because of unsatisfactory symptom management.
AHRQ-funded; HS022418.
Citation: Thienprayoon R, Marks E, Funes M .
Perceptions of the pediatric hospice experience among English- and Spanish-speaking families.
J Palliat Med 2016 Jan;19(1):30-41. doi: 10.1089/jpm.2015.0137.
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Keywords: Children/Adolescents, Palliative Care, Long-Term Care, Racial and Ethnic Minorities, Cancer
Rhodes RL, Nazir F, Lopez S
Use and predictors of end-of-life care among HIV patients in a safety net health system.
The authors examined completion of advance directives, use of palliative care, and enrollment in hospice among HIV patients who receive care at an urban safety net hospital. They found that the rates of advance directive completion, palliative care use, and hospice use were low. They recommended that advances should be made in identifying those patients earlier in their disease trajectories.
AHRQ-funded; HS022418.
Citation: Rhodes RL, Nazir F, Lopez S .
Use and predictors of end-of-life care among HIV patients in a safety net health system.
J Pain Symptom Manage 2016 Jan;51(1):120-5. doi: 10.1016/j.jpainsymman.2015.08.010.
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Keywords: Human Immunodeficiency Virus (HIV), Palliative Care, Urban Health
Du XL, Parikh RC, Lairson DR
Racial and geographic disparities in the patterns of care and costs at the end of life for patients with lung cancer in 2007-2010 after the 2006 introduction of bevacizumab.
The authors examined racial/ethnic and geographical disparities in cancer care and costs during the last 6 months of life for lung cancer decedents after the FDA's approval of bevacizumab. They found that there were substantial racial/ethnic and geographic disparities in the types of cancer care and costs in the last 6 months of life among lung cancer decedents, regardless of the length of survival times and hospice care status.
AHRQ-funded; HS018956.
Citation: Du XL, Parikh RC, Lairson DR .
Racial and geographic disparities in the patterns of care and costs at the end of life for patients with lung cancer in 2007-2010 after the 2006 introduction of bevacizumab.
Lung Cancer 2015 Dec;90(3):442-50. doi: 10.1016/j.lungcan.2015.09.017.
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Keywords: Cancer, Cancer: Lung Cancer, Disparities, Healthcare Costs, Medication, Palliative Care, Patient-Centered Outcomes Research, Practice Patterns, Racial and Ethnic Minorities
Ananth P, Melvin P, Feudtner C
Hospital use in the last year of life for children with life-threatening complex chronic conditions.
The researchers assessed hospital resource use in children by type and number of life-threatening complex chronic conditions (LT-CCCs). They found that hospital use for children with LT-CCCs in the last year of life varies significantly across the type and number of conditions. Children with hematologic/ immunologic or multiple conditions have the greatest hospital use.
AHRQ-funded; HS023092.
Citation: Ananth P, Melvin P, Feudtner C .
Hospital use in the last year of life for children with life-threatening complex chronic conditions.
Pediatrics 2015 Nov;136(5):938-46. doi: 10.1542/peds.2015-0260..
Keywords: Chronic Conditions, Children/Adolescents, Hospitalization, Palliative Care
Kamal AH, Kavalieratos D, Bull J
Usability and acceptability of the QDACT-PC, an electronic point-of-care system for standardized quality monitoring in palliative care.
The researchers performed usability testing of the Quality Data Collection Tool for Palliative Care (QDACT-PC), a novel, point-of-care quality monitoring tool for palliative care. They found that testing the QDACT-PC reveals equivalence with paper for data collection time, but with less burden overall for electronic methods across other domains of usability.
AHRQ-funded; HS022989.
Citation: Kamal AH, Kavalieratos D, Bull J .
Usability and acceptability of the QDACT-PC, an electronic point-of-care system for standardized quality monitoring in palliative care.
J Pain Symptom Manage 2015 Nov;50(5):615-21. doi: 10.1016/j.jpainsymman.2015.05.013.
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Keywords: Healthcare Delivery, Quality of Care, Palliative Care, Patient-Centered Healthcare, Quality Measures
Kamal AH, Harrison KL, Bakitas M
Improving the quality of palliative care through national and regional collaboration efforts.
The purpose of this paper was to review examples of quality-improvement collaborations in palliative care to understand the similarities, differences, and future directions of quality measurement and improvement strategies. These three examples showed areas of robust and growing quality-improvement collaboration in the field of palliative care: the Global Palliative Care Quality Alliance; Palliative Care Quality Network; and Project Educate, Nurture, Advise, Before Life Ends.
AHRQ-funded; HS023681.
Citation: Kamal AH, Harrison KL, Bakitas M .
Improving the quality of palliative care through national and regional collaboration efforts.
Cancer Control 2015 Oct;22(4):396-402. doi: 10.1177/107327481502200405.
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Keywords: Healthcare Delivery, Palliative Care, Quality of Care, Quality Improvement
Wysham NG, Cox CE, Wolf SP
Symptom burden of chronic lung disease compared with lung cancer at time of referral for palliative care consultation.
The authors compared the symptom burden of chronic lung disease with that of lung cancer at the time of initial palliative care consultation. They found that patients with chronic lung disease have symptom burdens similar to those of patients with lung cancer at the time of the first palliative care encounter. They concluded that, given the population burden of chronic lung disease and limitations in the palliative care workforce, attention should be focused on ensuring that pulmonologists are prepared to assess and manage the common palliative care needs of patients with chronic lung disease.
AHRQ-funded; HS023681.
Citation: Wysham NG, Cox CE, Wolf SP .
Symptom burden of chronic lung disease compared with lung cancer at time of referral for palliative care consultation.
Ann Am Thorac Soc 2015 Sep;12(9):1294-301. doi: 10.1513/AnnalsATS.201503-180OC.
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Keywords: Respiratory Conditions, Cancer: Lung Cancer, Pain, Palliative Care, Patient-Centered Outcomes Research
Holden TR, Smith MA, Bartels CM
Hospice enrollment, local hospice utilization patterns, and rehospitalization in Medicare patients.
The study objective was to examine the association between hospice enrollment, local hospice utilization patterns and 30-day rehospitalization in Medicare patients. It found that area-level hospice utilization is inversely proportional to rehospitalization rates. This relationship is not fully explained by direct hospice enrollment, and may reflect a spillover effect of the benefits of hospice extending to nonenrollees.
AHRQ-funded; HS000083.
Citation: Holden TR, Smith MA, Bartels CM .
Hospice enrollment, local hospice utilization patterns, and rehospitalization in Medicare patients.
J Palliat Med 2015 Jul;18(7):601-12. doi: 10.1089/jpm.2014.0395..
Keywords: Long-Term Care, Palliative Care, Hospital Readmissions, Medicare, Healthcare Utilization
DiBiasio EL, Clark MA, Gozalo PL
Timing of survey administration after hospice patient death: stability of bereaved respondents.
The authors examined the stability of bereaved family members' survey responses when administered three, six, and nine months after hospice patient death. They found that bereaved family member responses are stable between three and nine months after the death of the patient.
AHRQ-funded; HS019675.
Citation: DiBiasio EL, Clark MA, Gozalo PL .
Timing of survey administration after hospice patient death: stability of bereaved respondents.
J Pain Symptom Manage 2015 Jul;50(1):17-27. doi: 10.1016/j.jpainsymman.2015.01.006.
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Keywords: Family Health and History, Mortality, Palliative Care
Kamal AH, Nipp RD, Bull J
Symptom burden and performance status among community-dwelling patients with serious illness.
The researchers explored the relationship between prevalence and severity of symptoms and underlying performance status. They found distinct groupings of symptoms with high burden associated with different levels of performance status. This includes high prevalence of fatigue, anorexia, and dyspnea in patients with high performance. Patients with low performance status, however, reported more pain, depression, and constipation.
AHRQ-funded; HS022763.
Citation: Kamal AH, Nipp RD, Bull J .
Symptom burden and performance status among community-dwelling patients with serious illness.
J Palliat Med 2015 Jun;18(6):542-4. doi: 10.1089/jpm.2014.0381..
Keywords: Patient Safety, Quality of Life, Palliative Care, Health Status
Huo J, Du XL, Lairson DR
Utilization of surgery, chemotherapy, radiation therapy, and hospice at the end of life for patients diagnosed with metastatic melanoma.
The authors examined the patterns of utilization of radiation therapy, chemotherapy, surgery, and hospice at the end-of-life care for patients diagnosed with metastatic melanoma. They found that surgery and hospice care use increased over the 8 years of this study, whereas the use of chemotherapy and radiation therapy remained consistent for patients diagnosed with metastatic melanoma.
AHRQ-funded; HS018956.
Citation: Huo J, Du XL, Lairson DR .
Utilization of surgery, chemotherapy, radiation therapy, and hospice at the end of life for patients diagnosed with metastatic melanoma.
Am J Clin Oncol 2015 Jun;38(3):235-41. doi: 10.1097/COC.0b013e31829378f9.
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Keywords: Cancer, Cancer: Skin Cancer, Treatments, Elderly, Healthcare Utilization, Palliative Care, Patient-Centered Outcomes Research, Surgery
Smith B, McDuff J, Naierman N
What consumers want to know about quality when choosing a hospice provider.
This study drew on focus group and survey data collected in 5 metropolitan areas to learn more about hospice quality data. The researchers found that participants placed top priority on measures related to pain and symptom management. The National Quality Forum-approved measures resonate well with consumers, who also appear to be ready for access to data on the quality of hospice providers.
AHRQ-funded; HS021870.
Citation: Smith B, McDuff J, Naierman N .
What consumers want to know about quality when choosing a hospice provider.
Am J Hosp Palliat Care 2015 Jun;32(4):393-400. doi: 10.1177/1049909114524475.
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Keywords: Caregiving, Education: Patient and Caregiver, Decision Making, Palliative Care, Provider Performance, Public Reporting, Quality of Care, Quality Indicators (QIs)