Updated palliative care guidelines: Providers should increase coordination, embrace QAPI

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Palliative care should follow care coordination and quality improvement processes called for by the Affordable Care Act, according to updated guidelines from the National Consensus Project for Quality Palliative Care.

This is the first update of the “Clinical Practice Guidelines for Quality Palliative Care” since 2009. The changes were decided through a “consensus process” involving leading hospice and palliative care organizations.

The new guidelines reflect mandates of the 2010 healthcare reform law. The ACA's delivery and payment models opened the way for hospice and palliative care providers to join accountable care organizations and bundled payment groups, the guidelines note, and so best practices should be followed to promote palliative care across all settings.

Providers also should institute quality assessment and performance improvement (QAPI) reviews as part of an “ongoing data driven process” to improve outcomes, according to the guidelines.

“Quality improvement activities are routine, regular, reported, and demonstrate influence upon clinical practice,” the guidelines state. “Designated staff, with experience in QAPI planning, direct the QAPI process in collaboration with leaders of the palliative care program.”

The guidelines also “significantly revised and expanded” on the psychological and psychiatric aspects of care, including a new section on bereavement programs. The guidelines call for an assessment at the time of admission to identify families at risk of complicated bereavement, with a special focus on older adults at risk of developing co-morbid complications related to grief.

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