My career goal is to mature as an independent health services researcher, with a focus on quality and palliative care, to improve the experience of patients with serious and chronic illness and their caregivers. Palliative care is a newer clinical discipline focused on improving quality of life for all patients, independent of prognosis. Palliative care has achieved remarkable growth, with clinical services present in 66% of all hospitals. Despite such growth, a standardized clinical approach does not yet exist. Such an approach requires evaluating which care processes, recommended by published quality measures, improve patient-centered outcomes the most. Then, the care processes and associated quality measures with the greatest impact can be prioritized. We have developed the infrastructure to perform this investigation. Specifically, I led the development of QDACT-PC (Quality Data Collection Tool Palliative Care), a point-of-care, iPad(tm)-based data collection system that simultaneously populates a registry of care processes, quality measure adherence, and patient and health system outcomes. In September 2013, we were awarded an AHRQ R18 grant to implement QDACT-PC nationally in the Palliative Care Research Cooperative Group (PCRC), the first national research collaborative for palliative care. Analysis aims were reserved by my mentor and the PI of that proposal, Dr. Amy Abernethy, for this K08 application. My research goal is to use this quickly growing registry to explore the impact of quality measure adherence on outcomes in the palliative care setting. Under the guidance of my mentors, I will first, I will describe variability in clinician adherence to a set of 20 core palliative care qualiy measures among 1000 patients. Then, I will use quantitative and qualitative methods to determine the relationship between adherence to a set of palliative care quality measures and patient-reported outcomes, including satisfaction with care, quality of life, and symptom relief. Last, I will investigate the relationship between adherence to a set of quality measures and health service utilization, as measured by 30-day readmission rates, length of stay, and overall health care costs. Together, these aims alongside a robust career development plan and dedicated mentorship, will prepare me for an R01-level submission prospectively testing the identified core set on patient-centered outcomes.
There remains no tested set of prioritized quality measures in palliative care to guide best practices in the field. I, under the guidance of my mentors, will analyze the first national registry of quality measures in palliative care to understand which measures, when adhered to, improve patient-centered and health system outcomes of importance.
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