This indicator measures the proportion of hospitalizations where patients with a progressive, life-limiting illness are identified to benefit from palliative care, and subsequently (within the episode of care) have their palliative care needs assessed using a comprehensive and holistic assessment.

Quality Improvement Plans (QIPs)

Effective

Outcome

Limitations to this measure include that the needs change over time; patients may have more than one hospitalization; and needs may have been assessed in other settings as well. The quality of the assessments will not be captured, only completions.

The intent of the indicator is to influence a system change to 1) identify people who would benefit from palliative care as early as possible using a screening tool, and 2) to conduct a holistic assessment of their needs earlier in the disease trajectory. Identification does not mean a referral to a palliative care specialist. Instead, identification should prompt a comprehensive and holistic assessment to determine the patient’s full range of needs. Who are these patients? • The patient population will likely include identifying patients with palliative care needs earlier than has been done in the past. • Newly diagnosed, serious and life-limiting conditions • Newly diagnosed cancer with significant risk of progression • End-stage organ failure(s) • Frailty • Dementia • Multiple medical conditions • Existing condition with a new development Step 1: Early Identification (the denominator): Ask yourself, what screening process is currently in place in our organization to identify patients earlier who may have progressive, life-limiting illnesses, and would benefit from palliative care? Early identification screening would happen after the patient has been admitted to hospital, during inpatient admission assessment on the unit. Some tools used in Ontario include the Supportive and Palliative Care Indicators Tool (SPICT) and the Hospital-Patient One-Year Mortality Risk (HOMR). The Ontario Palliative Care Network’s Tools to Support Earlier Identification for Palliative Care is a great resource to help when determining this denominator. Step 2: Assessment of palliative care needs (the numerator): Once screening has identified patients who would benefit from palliative care, ask yourself, what process is currently in place in our organization to do a comprehensive and holistic assessment of their needs? Needs assessment: The patient’s current and future needs and preferences should be assessed across all domains of care. The Ontario Palliative Care Network’s Palliative Care Toolkit outlines the process, and suggested tools for Step 2. Health Quality Ontario’s Palliative Care Standard includes 13 Quality Statements. This indicator closely aligns with Quality Statement #1.

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