Assessing End-of-Life Care Quality Across Settings in an Integrated Healthcare Delivery System (TH310C)

Abstract

•Describe the development and testing of a patient- and family-centered end-of-life care survey to strengthen the evaluation of quality of end-of-life care across a large and diverse integrated delivery system.•Discuss how insights from the survey can be used to promote and guide quality improvement. Kaiser Permanente has implemented programs aiming to improve care at the end of life. To better understand patient care experience, we adapted existing instruments to develop and test a survey assessing quality of end-of-life care (EOLC) across all care settings. To assess the feasibility and value of using the KP EOLC Survey across an integrated delivery system. Survey domains were prioritized through a key stakeholder consensus building process. We scanned relevant literature on EOLC quality measurement and adapted items from validated instruments that mapped to each prioritized domain, drawing primarily from the VA’s Bereaved Family Survey (BFS). We conducted cognitive testing of drafted instrument on next-of-kin (NOK) respondents of deceased KP members. The final survey was administered via mail and followed up by telephone outreach to NOK respondents six months after decedent’s death date. 2,701 surveys were completed (25.6% response rate). Respondents were similar to non-respondents in decedent’s age, gender, and clinical profile. Respondents were mostly family members (85%) and reported being familiar with decedents’ health issues and treatment decisions (88%) and had discussed EOLC preferences with decedents (84%). Overall care in the last month of life was rated “excellent” by 53% of respondents and varied across regions and care settings. Eighty-eight percent of respondents agreed that KP gave care and treatment concordant with decedent’s wishes and 78% reported decedent passed away in preferred setting. Regional leaders are using survey results to inform quality improvement. The KP EOLC Survey was acceptable to family members and yielded response rates comparable to those reported in the literature. It provided valuable patient-centered information about EOLC outcomes across settings. Further assessment of survey psychometrics is warranted, and strategies to incorporate regular administration of the KP EOLC Survey across the organization are under development.