Hospice Provider Toolkit


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Welcome

The 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 Toolkit

The AIM Toolkit is built around a number of tools designed to:

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 Design

The 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:


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Acknowledgements

Special 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 Team

Rebecca 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
AIM Framework

References and Resources



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Page last modified: May 4, 2011
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