Quality Indicators for Pain in Palliative Care

Abstract

Measuring the quality of pain management is essential for comparing providers, targeting quality improvement efforts, and measuring the impact of quality improvement initiatives in palliative care. Recent development of quality indicators in cancer palliative care and in general palliative care populations has produced a variety of pain management indicators that have been evaluated for feasibility, reliability, and validity. Indicators are available for outpatient, inpatient, intensive care, and hospice settings, and address structure, process, and outcome, as well as the spectrum of care through screening, assessment, treatment, and follow-up. Quality measurement in pain is facilitated by the availability of well-validated pain assessment tools. However, implementation of these indicators is limited by the challenges of assessment in vulnerable populations; lack of consistent documentation of many aspects of pain management in the medical record; and the lack of evidence for correlation between quality indicators and patient outcomes. Further research is needed for pain indicators in children and those who cannot report pain, how to tailor pain quality measurement to different populations and settings, and on better integration of quality measurement and clinical care. More development is also needed on the nonphysical aspects of pain and its management, and interaction between the quality of pain management and other symptoms and domains of palliative care. The collection of patient-reported outcome data and the use of structured electronic medical record (EMR) documentation also have the potential for improving the measurement of the quality of pain management. Measuring the quality of pain management is essential for comparing providers, targeting quality improvement efforts, and measuring the impact of quality improvement initiatives in palliative care. Recent research has produced indicator sets focusing on pain management, in cancer palliative care, and in general palliative care populations that have been evaluated for feasibility, reliability, and validity. Indicator sets are available for outpatient, inpatient, intensive care, and hospice settings, and address the spectrum of care, through screening, assessment, treatment, and follow-up. Quality measurement in pain is facilitated by well-validated pain assessment tools but limited by the challenges of assessment in vulnerable populations, lack of consistent documentation of many aspects of pain management in the medical record, and the lack of evidence for correlation between quality indicators and patient outcomes. Collection of patient-reported outcome data and the use of structured EMR documentation have the potential for improving the future measurement of the quality of pain management.