Hospice Provider Toolkit
- About This Toolkit
- Toolkit Design
- Project Team
- Overview of AIM Quality Measures
- References and Resources
WelcomeThe Hospice AIM Project Team is pleased to release the Hospice Assessment Intervention and Measurement (AIM) Toolkit designed to help maintain and improve the quality of care for your patients and families. The purpose of this toolkit is to provide processes, resources, and tools to assist in developing and supporting a culture placing a high priority on quality improvement and superior patient and family comfort care, when curative treatment is no longer the patient's primary goal. The Toolkit lists the 12 AIM quality improvement measures, explains the tools needed to collect these measures, and discusses which tools to use for interpreting the collected data and improving hospice care.
About this ToolkitThe AIM Toolkit is built around a number of tools designed to:
- Measure quality care using a set of quality measures;
- Select areas for practice improvement based on the data;
- Implement practice interventions;
- Evaluate quality improvement activities.
The set of measures contained in this toolkit were first developed in 2008 by the Carolinas Center for Medical Excellence's Prepare, Embrace, Attend, Communicate, Empower (PEACE) Project under a contract with the Centers for Medicare and Medicaid Services (CMS).
Following the conclusion of the PEACE Project, CMS contracted with the Island Peer Review Organization (IPRO), the New York State Quality Improvement Organization (QIO), to test a selected set of the PEACE measures. This toolkit contains the measures that were considered usable, feasible, and reliable during the testing process.
The measures were tested in seven hospice settings with limited testing in one hospital based palliative care consult service. As a result, most of the lessons learned during the testing phase came from hospice settings. However, many of the elements can be used to measure quality care in other end-of-life care settings. We encourage anyone wishing to improve the quality of care provided to terminally ill patients to utilize the quality measures and tools that make sense for their agency.
We recognize there are many different types of organizational structures in which healthcare services are delivered. However, for simplicity we have chosen to refer to all types of programs as "agencies".
We recommend that Quality Improvement Organizations (QIOs) and other professional organizations partner with agencies in the quality improvement (QI) initiative. QIOs and other professional organizations can aid agencies by creating a collaborative culture to capitalize on existing resources, thus increasing the capacity to provide high quality care.
It is important to realize that quality measures development for hospice and palliative care is still in its infancy and the measures contained within this toolkit will most likely continue to evolve as the quality improvement initiative progresses.
Quality Improvement in Hospice: A National Effort
Roles for QIOs and Professional Organizations in the Quality Improvement Process
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Toolkit DesignThe AIM Toolkit is divided into six sections. The sections are designed to quickly navigate to areas of importance to you. Each of the main sections contains subheadings. Within each subheading we provide a list of relevant supporting materials and tools. At the end of each main section, we provide a list of additional resources (such as Web sites, books, journal articles, documents) that you may find helpful or interesting.
The sections are briefly described below:
This section discusses the reason behind using a standardized set of quality measures in hospice and palliative care and the purpose of the toolkit.
This section provides the steps an agency should follow to prepare for implementing the AIM Process including an agency changes and transitions discussion.
- AIM Data Collection Process
This section explains the AIM Data Collection Process including training details for data collection and achieving reliability.
- Calculating Quality Measures
This section describes how to calculate and understand the AIM Quality Measures and includes the measures' technical specifications.
- Practice Changes
This section provides an overview of the processes for quality and performance improvement, suggestions for interventions, a discussion of cultural diversity in hospice and palliative care, and resources submitted from other hospices in the United States.
This section includes the references (journal articles, clinical resource books, general books, and Web sites) that pertain to each section of the toolkit.
AcknowledgementsSpecial thanks to the Technical Advisory Panel members for their input and to Timothy Quill, MD, for his valuable contribution of clinical direction and support throughout the project.
Technical Advisory Panel
We would also like to extend our deepest appreciation to the participating agencies for their commitment and dedication to implementing and testing the AIM Process and the quality measures.
AIM Project Participating Agencies
Many thanks to CMS for their support of the work for developing this toolkit under the 9th Scope of Work Special Study Hospice AIM Project and our sincere appreciation to Danielle Shearer, Hospice AIM Project Government Task Leader, and Craig Bagley, Project Officer. We would also like to extend our appreciation to Cindy Massuda, Judy Tobin, and Shari Ling for informing the direction of this toolkit.
Project TeamRebecca Van Vorst, MSPH; Carol Shenise, MS, RN; Susan Wymer, MS, BSN, RN; Steven Szebenyi, MD, MMM; Timothy Quill, MD; Thomas Hartman; Ti-Kuang Lee, MS, ScM; Karen Lasher
Overview of AIM Quality Measures
The AIM Quality Measures cover seven domains and address both regulatory processes published in the 2008 final Medicare Conditions of Participation (CoP) and aspects of hospice care that are important, scientifically acceptable, feasible, and useful in practice.
The AIM Quality Measures were tested in eight hospice and palliative care agencies in New York State over the period of one year. Participating agencies implemented and evaluated the utility of the measures and the education and training resources contained in this toolkit.
We incorporated the experiences and lessons learned during all phases of the testing into the tools and materials. We learned that agencies believed they could benefit from using the AIM Quality Measures and could easily incorporate the AIM Framework into their current Quality Assessment and Performance Improvement (QAPI) process.
AIM Quality Measures by Domain
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