Quality improvement for hospice and palliative care

Traditional safety metrics don't translate cleanly to end-of-life care. A fall prevention protocol designed for an acute care patient may conflict with a hospice patient's wish to stay mobile at home. A medication change that would be a near miss elsewhere may be a deliberate titration for symptom control.

Events have to be understood against the patient's goals of care and expected disease progression. The same fall or respiratory change means something different under a comfort-focused plan than under a plan aimed at recovery. Data captured without that context is misleading and can demoralize the care team.

Family experience is central to hospice quality and hard to capture. Whether pain was controlled, whether the family felt supported and whether the final days reflected the patient's wishes define good hospice care, and none of it appears in an incident report.

Hospices must run a hospice-wide, data-driven QAPI program under 42 CFR 418.58 that focuses on palliative outcomes, tracks adverse patient events, analyzes their causes and prioritizes high-risk, high-volume and problem-prone areas, with performance improvement projects.

• The Hospice Outcomes and Patient Evaluation (HOPE) tool replaced the Hospice Item Set on October 1, 2025. It collects data at admission, at update and symptom follow-up visits and at discharge.
• The Hospice Quality Reporting Program also includes the claims-based Hospice Care Index and Hospice Visits in the Last Days of Life measures, and the CAHPS Hospice Survey of family caregivers.
• The interdisciplinary group must review and revise each patient's plan of care as often as the condition requires, and at least every 15 calendar days.
• CMS stopped implementing the Hospice Special Focus Program for 2025 in February 2025 to evaluate it further.

1. 1Define hospice-specific event categories, such as uncontrolled symptoms, medication access problems, unplanned transfers and family concerns, and record the goals of care with each event.
2. 2Make sure HOPE data is collected reliably at every required visit; it is now the basis of your quality reporting.
3. 3Review CAHPS Hospice results with the interdisciplinary group and pick one area of family experience to improve.
4. 4Bring event patterns into the regular IDG review so they inform care planning, not just compliance.
5. 5Check in on staff regularly; compassion fatigue is a real risk to retention and care quality.

• Configurable event categories that reflect hospice care, reported from any device during a home visit and routed to the right reviewer.
• Severity, status and tags on each event, so you can separate expected changes from events that need review.
• Well-being pulse checks that reach staff in the field, for a workforce carrying a heavy emotional load.