Table 2.

Performance of Consultative Palliative Care on Patient-Level Measures of Quality of ICU-Based Palliative Care

RWJF/SCCM* Quality Measure	Description of Measure in QDACT	Metric adherence / eligible (%) (N=254)	Responses
1. Assessment of patient decisional capacity	Asked to choose whether patient has capacity: yes/no	22/254 (8.7%)	Patient has Capacity	8/22 (36.3%)
			Patient Lacks Capacity	14/22 (63.6%)
2. Identification of surrogate decision-maker	If lack of capacity documented, clinician is asked to indicate if a proxy is documented	14 /14^ (100%)
3. Presence and contents of advanced directive	Clinician is asked to document the presence of an advanced directive	91/254 (35.8%)	Advanced directives present	54/91 (59.3%)
			Advanced directives absent	37/91 (40.7%)
10. Offer of psychosocial or emotional support	Clinician is asked to document a patient’s emotional wellbeing	115/254 (45.3%)	Adequate emotional wellbeing	41/115 (35.7%)
			Poor emotional wellbeing	74/115 (64.3%)
11. Pain assessment	Number of patients with documentation of pain assessment	132/254 (52.0%)	Pain present (any severity)	94/132 (71%)
			Pain not present	38/132 (28.8%)
12. Pain management	Number of patients with moderate/severe pain who had an intervention recorded for pain management	37/37^ (100%)
13. Respiratory distress assessment	Number of patients with documentation of respiratory distress assessment	129/254 (50.8%)	Respiratory distress present	96/129 (74.4%)
			Respiratory distress not present	33/129 (25.6%)
14. Respiratory distress management	Number of patients with moderate/severe respiratory distress who had an intervention recorded for respiratory distress management	46/47^ (97.9%)
17. Offer of spiritual support	Clinicians are asked to assess 2 items: spiritual well being and “are you at peace?” This is measured if either is answered	158/254 (62.2%)	Spiritual well-being present	65/158 (41.1%)
			Poor spiritual well-being	93/158 (58.8%)

The proposed measure is paired with the description of the surrogate measure from QDACT and the performance on that measure. The right hand column presents patients’ outcomes on these items.

^{^}The measures apply to all patients except items 2, 12, and 14. In these, the denominators reflect the numbers eligible. For item 2, only patients who have lack of capacity documented require identification of surrogates. For items 12 and 14, only patients with moderate or greater symptoms require intervention.

^*RWJF-SCCM: Robert Wood Johnson Foundation and Society for Critical Care Medicine End of Life Peer Workgroup’s proposed measures of quality palliative care in the ICU. The numbers correspond to the initial numbers in that document.⁴