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Patients should receive palliative care much earlier than they often do. Ultimately, receiving timely palliative care provides benefits for both patients and the health system, supporting patients to die in their preferred place of death with the supports they need. Health care providers in all sectors have a role to identify patients with palliative care needs.

The priorities for the 2019/20 QIPs include a new indicator for the hospital, primary care, home and community care, and long-term care sectors to measure Early identification: Documented assessment of palliative care needs for an early, at-risk cohort. This indicator is designed to support organizations in taking the first steps to identify people with palliative care needs earlier.

Review the Indicator Technical Specifications for the 2019/20 QIPs to learn about how to measure this indicator.

Key resources on palliative care that will be useful in working on this indicator include:

• Health Quality Ontario’s quality standard on palliative care, particularly Quality Statement 1: Identification and Assessment of Needs
• The Ontario Palliative Care Network’s Palliative Care Toolkit, particularly Step 1: Identify and Step 2: Assess

How to measure this indicator

This indicator is new in the 2019/20 QIPs, so organizations may spend the first year focusing on integrating measurement into their workflows. The indicator can be measured using several steps:

1. Identify patients who may be at risk of having palliative care needs. This population may include people with:

• Newly diagnosed, serious and life-limiting conditions
  • Newly diagnosed cancer
  • End-stage organ failure(s)
  • Frailty
  • Dementia
• An existing condition with a new development
• Complex and/or chronic conditions (Health Links definition)

2. Conduct a screen to identify patients who do in fact have palliative care needs (denominator).

• Review Step 1: Identify in the Ontario Palliative Care Network's Palliative Care Toolkit.

3. Conduct a comprehensive needs assessment on the people who are identified as having palliative care needs (numerator).

• Review Step 2: Assess in the Ontario Palliative Care Network's Palliative Care Toolkit.

How to improve on this indicator

The following approaches may help to improve early identification of people with palliative care needs.

1. Conduct training to ensure staff are able to:

• Use screening tools to identify patients with palliative care needs early (denominator)
• Conduct palliative care needs assessments (numerator) and follow up as appropriate

2. Design and test processes, policies and procedures to identify patients who have palliative care needs early and conduct needs assessments

3. Embed flags, prompts and reminders in electronic medical record systems to:

• Identify patients who may be at risk of having palliative care needs
• Identify patients who were screened and identified to have palliative care needs (denominator)
• Collect data on whether a palliative care needs assessment was completed (numerator)

Have you been working on any of these approaches in your organization? Comment below to share what you think should be done to improve on this indicator.

Visit Quorum’s Indicators & Change Ideas page for more information on this indicator for hospital, primary care, home and community care, and long-term care sectors.

This year’s Quality Improvement Plan (QIP) program focuses on a smaller number of priorities with an emphasis on critical issues that require a cross-sector focus. The priorities focus on three core themes: timely and efficient transitions, service excellence, and safe and effective care. Each theme includes a list of indicators that organizations are strongly encouraged to work on throughout the year.

This post is part of a series highlighting the new themes and 2019/20 QIP indicators. Visit the QIP 2019/20 tag to see the latest.