ENA Emergency Nurses Association - Collaborative Opportunities

Collaborative Opportunities for Emergency Nurses

PALLIATIVE CARE GUIDELINES AND FRAMEWORK

Palliative care is a health care approach that seeks to provide the best possible quality of life for people with chronic, progressive, or life-threatening illnesses. Palliative care services support patients of all ages and their families, in accordance with their particular values, needs, and preferences, through the full course of illness, until a cure is achieved or death results, and continuing on through the time of family bereavement. In the U.S., palliative care will become increasingly more important in coming years as the baby-boom generation grows older

The NCP Guidelines and the NQF Framework

Overview
To standardize palliative care practices for the growing number of people with life-threatening or debilitating illness, two national initiatives have defined the core domains of palliative care: the National Consensus Project for Quality Palliative Care (NCP) and the National Quality Forum�s (NQF�s) Framework and Preferred Practices for a Palliative and Hospice Care Quality Project.

The NCP released its Clinical Practice Guidelines for Quality Palliative Care in April, 2004. Using the Guidelines as a primary resource, the NQF released A National Framework for Palliative and Hospice Care Quality Measurement and Reporting in February, 2007.

Commonalities
Since the NQF Framework is based largely on the NCP�s Guidelines, the two documents have much in common:

Both attempt to formalize the concept of palliative care by providing extended descriptions and definitions differentiating palliative from other types of care.

Each structures the theory and practice of palliative care into eight domains: (1) structure and process of care, (2) physical aspects of care, (3) psychosocial and psychiatric aspects of care, (4) social aspects of care, (5) spiritual, religious, and existential aspects of care, (6) cultural aspects of care, (7) care of the imminently dying patient, and (8) ethical and legal aspects of care. These domains address such matters as, for instance, how an interdisciplinary care team may best be assembled and how continuity of care across diverse health care settings can be ensured.

Differences
Since each document has a specific function unique to the mission of the sponsoring organization, they differ in significant ways:

Although the NCP Guidelines and NQF Framework are both based on the consensus of palliative care experts, the NQF Framework is intended to be the first step in a process through which rigorous, quantifiable internal and external quality indicators are developed. The NCP Guidelines, in contrast, include extensive background on the history and philosophy of palliative care and are carefully referenced to the evidence base from which they were drawn.

The NCP Guidelines are intended to provide guidance across a range of palliative care delivery settings. The NQF Framework provides a concise structural definition of quality palliative care, as prerequisite for the identification and testing of quality measures.

The NCP Guidelines present recommended practices within each domain, while the NQF Framework defines each domain as a particular problem to be addressed through a specific set of �preferred practices.�

The NQF Framework will lead to palliative care standards, with implications for reimbursement, internal and external quality measurement, regulation, and accreditation.

Recommendation
The NCP recommends that the two documents be used in conjunction with one another to guide the development of new palliative care programs, improve existing ones, and demonstrate compliance with consensus standards for quality palliative care.

For More Information

www.qualityforum.org

www.nationalconsensusproject.org

The following document provides an overview of the NQF Framework.

Ken Zuroski, PhD
National Consensus Project
412.787.1002
kenz@hpna.org