The impact of end-of-life quality metrics on date of death and hospice documentation over time.

Abstract

e23009 Background: Patient experience and quality of care at the end of life (EOL) have become increasingly important for Oncology providers with the shift to value-based care (VBC). Medicare VBC programs such as the Oncology Care Model (OCM) and Enhancing Oncology Model (EOM) encourage care transformation and use quality measurement to drive EOL quality improvements. Timely and accurate documentation allows practices to evaluate their own performance and continuously improve care transformation efforts. We studied documentation trends in the electronic health record (EHR) and compared them with Medicare claims to evaluate the impact quality metrics had on ensuring accurate practice documentation. Methods: Best practices were established, and continuous education was provided to enable capture and recording of key EOL data in the EHR beginning in July 2016. Patient level date of death (DOD) and hospice enrollment (HSP) data were provided by CMS during the OCM (July 2016 - June 2022) for 14 participating practices in The US Oncology Network (The Network). We obtained corresponding DOD and HSP data from the EHR and compared documentation trends between systems. Statistical analysis was performed for increasing/decreasing trends using the Mann Kendall test. Results: There were statistically significant increases in EHR DOD (19.37% increase, p value 0.02) and HSP (18.93% increase, p value 0.002) documentation from 2016 -2022. All practices had an average year over year increase of 16.40% in HSP documentation (range 11.94% - 18.93.%) and 16.24% increase in DOD documentation (range 6.49% - 19.37%). The median increase from 2016 to 2022 in documentation of DOD was 68% (range 37% - 92%) and HSP was 48% (range 12% - 83%) for all practices. Conclusions: As an epitome of the Hawthorne effect, EOL quality metrics drive clinical documentation improvements with DOD and HSP, further accelerated by continuous education and the establishment of best practices. Improved clinical documentation aids care transformation and quality improvement, creating a positive feedback loop. The impact of quality measurement on other structured and unstructured documentation in the EHR is apt for further exploration. CMMI Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document. [Table: see text]