“We want to improve our practices. We want to improve patient outcomes”: An Evaluation of UCLA Health’s Data-Sharing Partnership with 12 Hospice Agencies Open Access
Greenberg, Ilana (Spring 2020)
Abstract
Background:
Hospice care is specialized care for people at the end of their life (End of Life Care, n.d.) that relieves patient suffering while delivering services often within the home environment (Kumar et al., 2016). The use of hospice services has been linked to improvements in patient outcomes and satisfaction (Meier, 2011). Hospice admissions within the last six months of life are significantly associated with improved patient satisfaction, better pain control, reduced hospital days, and fewer hospital deaths (B. Black et al., 2011; Kleinpell et al., 2019).
UCLA Health, an academic medical center located in Los Angeles, California, has partnerships with 12 local hospice agencies. UCLA Health does not provide its own outpatient hospice care and relies on community-based hospice agencies to provide hospice care. As part of the relationship between UCLA Health and the hospice agencies, monthly data regarding the status of UCLA Health patients who have made contact with any of the hospice agencies are reported by the hospices to UCLA Health.
Purpose:
Informed by the theory of interorganizational relations, the overall purpose of this thesis is to evaluate the current partnerships between UCLA Health and hospice agencies. This will be achieved through the following aims:
1. Describe the current state of collaboration between hospice agencies and UCLA Health
2. Examine stakeholders’ perceptions of the collaboration between hospice agencies and UCLA Health
3. Assess end-of-life quality of care, by hospice agency, for UCLA Health patients
Methods:
A mixed-methods approach was utilized for this evaluation. In order to determine the current state of collaboration between hospice agencies and UCLA Health, the frequency of monthly data reporting was determined from 2018 to 2019 and trends were compared. In order to examine stakeholders’ perceptions of the collaboration between hospice agencies and UCLA Health, key informant interviews were conducted with three hospice stakeholders and two UCLA Health stakeholders. In order to assess end-of-life quality of care for UCLA Health patients by each hospice agency, descriptive statistical analysis was performed on measures such as age, hospice enrollment, reason for non-enrollment, discharge status, and length of stay.
Results:
The results showed that the majority of hospices remained consistent in their reporting of data between 2018 and 2019. There was one hospice agency who had high reporting rates in 2018, but dropped off in 2019. The key informant interviews revealed five key themes: improving the efficiency and content of the current spreadsheet format, common shared goal of improving quality of care, desire for mutually beneficial collaboration, frequency of receiving feedback, and desire for comparison to other hospices through feedback loop. The quantitative analysis revealed differences in quality of care between the hospice agencies, including in length-of-stay and discharge status.
Recommendations:
There are a total of five recommendations that emerged from this evaluation:
1. Implement monthly data report back to hospice agencies, including comparisons to the other hospice agencies in partnership with UCLA Health.
2. Schedule a regular quarterly conference call with all of the hospice agencies. In addition to these regularly scheduled calls, communicate with hospice agencies that they can contact UCLA Health about the data-sharing process at any time.
3. Monitor national quality data from Hospice Compare website and evaluate in context of hospice partnerships.
4. Reduce current security features on the spreadsheet to enable hospices to have fewer barriers to data entry.
5. Evaluate the master spreadsheet based on necessity and usefulness of information.
Table of Contents
CHAPTER 1: LITERATURE REVIEW 1
Landscape of End-Of-Life Care in the United States 1
Hospice Care 3
Hospice Utilization 5
Levels of Hospice Care 5
Measuring Hospice Quality of Care 7
Outcomes of Hospice Utilization 9
Hospice and Health System Collaboration 10
Theoretical Framework 12
Evaluation Aims 14
CHAPTER 2: PROGRAM DESCRIPTION 15
UCLA Health-Hospice Data-Sharing History and Partnership 16
PRIME Hospice Quality Measures 19
CHAPTER 3: STAKEHOLDER DESCRIPTION 21
UCLA Health 21
UCLA Health Palliative Care 21
UCLA Health Quality Management Services 22
Hospice Agencies 22
Hospice 1 23
Hospice 2 23
Hospice 3 23
Hospice 4 23
Hospice 5 24
Hospice 6 24
Hospice 7 24
Hospice 8 24
Hospice 9 24
Hospice 10 25
Hospice 11 25
Hospice 12 25
National Metrics of Hospice Agencies 25
Family Caregivers’ Survey Scores 26
Quality of Patient Care Scores 28
CHAPTER 4: METHODOLOGY 30
Evaluation Aim 1 Methodology: 30
Frequency of Monthly Spreadsheet Reporting 30
Evaluation Aim 2 Methodology: 31
Key Informant Interviews 31
Sample and Recruitment 31
Data Collection 32
Data Analysis 33
Evaluation Aim 3 Methodology: 34
Quantitative Data Analysis 34
CHAPTER 5: RESULTS 37
Evaluation Aim 1 Results: 37
Frequency of Monthly Spreadsheet Reporting 37
Evaluation Aim 2 Results: 38
Key Informant Interview Results 38
Evaluation Aim 3 Results: 46
Quantitative Data Analysis 46
CHAPTER 6: CONCLUSIONS AND RECOMMENDATIONS 53
Summary and Discussion of Key Findings 53
Strengths 55
Limitations 56
Recommendations 56
Conclusions 59
REFERENCES 60
APPENDIX 71
About this Master's Thesis
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