Palliative care and hospice focus on the relief of suffering and achieving the best possible quality of life, including ameliorating symptoms, relieving psychological distress, and promoting spiritual well-being for patients their caregivers. The growth of palliative care programs and services in the United States has paralleled the increased realization of the need for a rational, specialized approach to the care for people with advanced life-limiting chronic illness. A relatively new subspecialty, palliative care is building ts evidence base supporting clinical practice. A new National Institute of Nursing Research funded national research network, the Palliative Care Research Cooperative Group (PCRC), is an efficient mechanism for evidence development including comparative effectiveness research. The fundamental next step is efficient implementation of new evidence and emerging clinical care guidelines into practice. Quality monitoring and performance improvement initiatives are an important approach to reinforce evidence implementation. Over the past 5 years, a regional point-of-care quality monitoring program called QDACT-PC has been developed and piloted in North Carolina;it has been demonstrated to be well-liked by clinicians, usable, feasible, and able to generate reliable information that can be used to benchmark conformance with palliative care quality metrics, drive continuous quality improvement (CQI) activities, and reinforce best practice. One example of low conformance with quality metrics identified in QDACT-PC was related to constipation management;data demonstrate that less than 50% of patients are receiving current best practice interventions to manage constipation and that the symptom is persisting at moderate to severe levels until death. We propose to introduce QDACT-PC within engaged research and clinical care footprint of the PCRC to create a national network for point-of-care palliative care quality monitoring, and demonstrate its capabilities for conducting CQI projects and reinforcing contemporary standards for clinical best practice.
Specific aims of the project include: (1) To develop and nationally implement a PCRC specific version of QDACT-PC (named QDACT-PCRC). Upgrades planned for QDACT-PCRC include the addition of new data elements and question modules about caregivers, clinical sites characteristics, hospital-based palliative care, and questions relevant to Aims 2 and 3. (2) To demonstrate the use of QDACT-PCRC for CQI by conducting a network-wide CQI project in constipation management. QDACT-PCRC will be used to benchmark current conformance across all sites. PCRC clinical providers will develop a performance improvement program to address the symptom and its management. We will use QDACT-PCRC to monitor impact of the initiative, implementing iterative enhancements to the performance improvement program in order to achieve a goal of >90% conformance. (3) To test the use QDACT-PCRC as a mechanism for delivering clinical decision support that reinforces agreed best clinical practice. Palliative Medicine has recently proposed five clinical activities that should not be conducted as a part of ABIM's Choosing Wisely campaign (e.g. PEG tubes at end of life). We will use QDACT-PCRC to measure current rates of these activities being conducted at PCRC sites, to deliver a point- of-care real time education and clinical decision support module to reinforce best practice and to monitor impact, with iterative cycles of system updates as needed based upon impact. The expected outcome of this project is a national system of real-time point-of-care quality monitoring for palliative care, wit demonstrated capabilities to support CQI and implementation of best evidence. A corollary outcome is an aggregating dataset of quality monitoring and clinical implementation information, forming the PCRC Registry - intended to be a national resource to support quality monitoring, research and learning health care.

Public Health Relevance

This project combines the capabilities of the Palliative Care Research Cooperative Group (PCRC) and a collaboratively designed point-of-care quality monitoring program for palliative care to generate a national network for quality monitoring in palliative care called QDACT-PCRC. The result of achieving the QDACT-PCRC aims will be a highly efficient, standardized system to support quality benchmarking and evidence implementation through quality improvement initiatives, ultimately enhancing and improving care for people with serious and life limiting illnesses.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
Project #
Application #
Study Section
Special Emphasis Panel (HSQR)
Program Officer
Azam, Irim
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Duke University
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
Hochman, Michael J; Yu, Yinxi; Wolf, Steven P et al. (2018) Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies. J Pain Symptom Manage 55:82-88.e1
Bostwick, Doran; Wolf, Steven; Samsa, Greg et al. (2017) Comparing the Palliative Care Needs of Those With Cancer to Those With Common Non-Cancer Serious Illness. J Pain Symptom Manage 53:1079-1084.e1
Kamal, Arif H; Bull, Janet; Wolf, Steven P et al. (2017) Unmet Needs of African Americans and Whites at the Time of Palliative Care Consultation. Am J Hosp Palliat Care 34:461-465
Nikolich-┼Żugich, Janko; Goldman, Dana P; Cohen, Paul R et al. (2016) Preparing for an Aging World: Engaging Biogerontologists, Geriatricians, and the Society. J Gerontol A Biol Sci Med Sci 71:435-44
LeBlanc, Thomas W; Ritchie, Christine S; Friedman, Fred et al. (2016) Adherence to Measuring What Matters Items When Caring for Patients With Hematologic Malignancies Versus Solid Tumors. J Pain Symptom Manage 52:775-782
Kamal, Arif H; Bull, Janet; Ritchie, Christine S et al. (2016) Adherence to Measuring What Matters Measures Using Point-of-Care Data Collection Across Diverse Clinical Settings. J Pain Symptom Manage 51:497-503
Kamal, Arif H; Hanson, Laura C; Casarett, David J et al. (2015) The quality imperative for palliative care. J Pain Symptom Manage 49:243-53
LeBlanc, Thomas W; Nipp, Ryan D; Rushing, Christel N et al. (2015) Correlation between the international consensus definition of the Cancer Anorexia-Cachexia Syndrome (CACS) and patient-centered outcomes in advanced non-small cell lung cancer. J Pain Symptom Manage 49:680-9
Kamal, Arif H (2015) Signposts along the journey toward high-quality palliative care: the value of measuring what matters. J Pain Symptom Manage 49:e1-2
Kamal, Arif H; Nipp, Ryan D; Bull, Janet et al. (2015) Symptom Burden and Performance Status among Community-Dwelling Patients with Serious Illness. J Palliat Med 18:542-4

Showing the most recent 10 out of 14 publications