The Role of Feeling “Heard and Understood” in Promoting and Measuring the Receipt of Goal-Concordant Care in Advanced Cancer (QI131)

• Published in: Journal of pain and symptom management Vol. 65; no. 5; pp. e637 - e638
• Main Authors: Loggers, Elizabeth T., Case, Amy, Chwistek, Marcin, Guay, Marvin Delgado, Grossman, Steven R., Gustin, Jillian, di Ciccone, Barbara Lubrano, Nelson, Judith, Reddy, Akhila, Tulsky, James, Zachariah, Finly, Landrum, Kristen McNiff
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-05-2023
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2023.02.246

1. Describe the patient-reported, outcome-based performance measure “Heard & Understood” (HUD), which was developed by AAHPM.
2. Determine whether the HUD quality measure is appropriate for your quality improvement project.
Our ability to assess goal-concordant care (GCC) is limited by the lack of valid and reliable measures. The Alliance of Dedicated Cancer Centers’ (ADCC) 10 cancer hospitals implemented the Improving Goal Concordant Care Initiative (IGCC) to address gaps in GCC via communication skills training for oncologists with concurrent improvements in institutional support for this work at each site. IGCC includes a wholistic set of quality measures (QM) to evaluate GCC; this abstract focuses on the patient-reported, outcome-based performance measure (PRO-PM) “Heard & Understood” (HUD).
IGCC included oncology, palliative care (PC), and quality experts, and patient and family advisors, to identify core components for implementation and evaluation via QMs that were assessed for inclusion based on feasibility and priority ratings. This 3-year initiative started in 2020 with staggered implementation of QMs beginning Spring 2022. AAHPM developed and validated HUD PRO-PM based on the CMS Blueprint/NQF requirements to assess the quality of care provided by PC clinicians; HUD was adapted for use in this setting.
A QM workgroup identified 60 measure concepts. Nineteen QMs were selected; two are direct patient outcome measures. Other IGCC measures include: % completion of training; perceived value of training; self-efficacy and distress following training; electronic health record documentation (EHRD) of GCC; EHRD of PC and hospice referrals, and healthcare proxy; and claims-based, end-of-life utilization. HUD PRO-PM was highly prioritized; the survey and scoring are being added to Press-Ganey surveys at each site. This abstract will report on implementation, results, plan for future use, and learning lessons.
IGCC created a set of measures to assess goal-concordant care, including the extent to which patients felt heard and understood by their primary oncologist and team, with the goal of expanding the use of this measure to other cancer settings to guide future quality improvement efforts.