Quality Measures for the U.S. Hospice System

Academic research analyzing hospice quality and performance is limited. The purpose of this exploratory study is to investigate potential measurements to address quality within the U.S. hospice system. We endeavor to use Medicare Hospice Cost Report data for 2000 through 2007 to operationalize three constructs of quality—operational, labor, and clinical. These constructs are an attempt to answer the call for quality measures that focus on the following areas: (1) how the organization is functioning, (2) how the workforce is improving, and (3) how to measure changes in the patient’s condition. We examine these hospice quality measures in both nonprofit (NP) and for-profit (FP) hospice providers. Our sample includes 7,039 observations for the investigation period. Our results indicate that hospice quality significantly improves for our sample. These findings also hold when separately examining for-profit and nonprofit hospice providers. To our knowledge, research has not fully explored potential measures of hospice quality. Our exploratory study is an attempt to bridge dialogue between research and practice to further the discussion of quality in hospice care. Quality is a difficult concept to measure when referring to hospice care especially since the patients are terminally ill and are expected to die. Quality care consists of keeping the patient comfortable as he/she goes through the dying process. For this reason typically quality standards are not applicable, and our findings assist in the development of performance-related hospice quality measures.