Use of the consideRATE and integRATE Measures to Assess Care Quality in Inpatient Palliative Care

Despite recognition of the importance of measuring the quality of palliative care, there are significant gaps in information about how to do so in real-world settings, particularly for patient-reported experience measures (PREMs).

To institute a routine process of quality measurement using PREMs to support quality improvement and service recovery, in a single center inpatient palliative care unit in the United States.

Volunteers with prior healthcare experience administered two PREMs: consideRATE (a measure of patient serious illness experience) and integRATE (a measure of healthcare team integration). We calculated both item and overall mean scores, and top-box scores to mitigate potential ceiling effects. Negative or critical complaints were promptly brought to the unit nurse manager for real-time service recovery.

The overall mean consideRATE score was 3.88 (highest score possible of 4), and the overall mean integRATE score was 3.91 (highest score possible of 4). Top-box scores were 70% for consideRATE, and 75% for integRATE. The majority of the feedback given was positive. Opportunities for improvement of the unit environment, communication with patients and families, and the nursing and medical care, were identified. In some cases, critical feedback was acted on in real time to allow for service recovery.

Using consideRATE and integRATE in routine care is feasible, allows for effective identification of patient and family concerns about care, and should be considered for other palliative care settings.