Measure Summaries
Gramling, Robert, MD, DSc, University of Vermont
Palliative care inpatient experiences: percentage of hospitalized patients who reported that they felt heard and understood by doctors, nurses, and hospital staff on the Heard & Understood item.
Measure Domain
Primary Measure Domain
Clinical Quality Measures: Patient Experience
Secondary Measure Domain
Does not apply to this measure
Brief Abstract
Description
This measure is used to assess the percentage of hospitalized patients who reported that they felt heard and understood by doctors, nurses, and hospital staff on the Heard & Understood item.
The Heard & Understood measure is calculated based on the patients' responses ("Completely," "Quite a Bit," "Moderately," "Slightly," "Not at All") to the following item:
- Over the past two days, how much have you felt heard and understood by the doctors, nurses and hospital staff?
Two scoring options are used to calculate the measure:
- Option A ("At Goal"): Number of respondents who endorse "Completely"
- Option B ("At or Near Goal"): Number of respondents who endorse either "Completely" or "Quite a Bit"
Rationale
Promoting health care environments where patients feel heard and understood by those caring for them is essential to ensure value-concordant decision making (Elwyn et al., 2014; Epstein & Gramling, 2013; Epstein & Street, 2007), enhance dignity (Chochinov et al., 2015; Houmann et al., 2014), and relieve suffering (Cassel, 1982; Cassell, 1999). Nonetheless, seriously ill persons all too often feel silenced, ignored, and misunderstood in modern medical institutions (Institute of Medicine [IOM], 2015; Frosch et al., 2012; Norton et al., 2003). Systematically monitoring, reporting, and responding to how well patients feel heard and understood are crucial to create and sustain a health care environment that excels in caring for those who are seriously ill.
"Measuring What Matters" (MWM) (Dy et al., 2015) is a national palliative care quality improvement effort to identify, promote, and refine measurable indicators of high-quality care for seriously ill patients. The first MWM consensus statement (Dy et al., 2015) defined nine specific measures and called for the development of a 10th item to capture patients' global assessment of their health care quality. Toward this 10th aim, the developer designed a novel field measure of the degree to which seriously ill patients feel heard and understood by those caring for them in the hospital environment.
Evidence for Rationale
Cassel EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982 Mar 18;306(11):639-45. PubMed  |
| Cassell EJ. Diagnosing suffering: a perspective. Ann Intern Med. 1999 Oct 5;131(7):531-4. PubMed |
| Chochinov HM, McClement S, Hack T, Thompson G, Dufault B, Harlos M. Eliciting personhood within clinical practice: effects on patients, families, and health care providers. J Pain Symptom Manage. 2015 Jun;49(6):974-80. PubMed |
| Dy SM, Kiley KB, Ast K, Lupu D, Norton SA, McMillan SC, Herr K, Rotella JD, Casarett DJ. Measuring what matters: top-ranked quality indicators for hospice and palliative care from the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association. J Pain Symptom Manage. 2015 Apr;49(4):773-81. PubMed |
| Elwyn G, Lloyd A, May C, van der Weijden T, Stiggelbout A, Edwards A, Frosch DL, Rapley T, Barr P, Walsh T, Grande SW, Montori V, Epstein R. Collaborative deliberation: a model for patient care. Patient Educ Couns. 2014 Nov;97(2):158-64. PubMed |
| Epstein RM, Gramling RE. What is shared in shared decision making? Complex decisions when the evidence is unclear. Med Care Res Rev. 2013 Feb;70(1 Suppl):94S-112S. PubMed |
| Epstein RM, Street RL. Patient-centered communication in cancer care: promoting healing and reducing suffering. Bethesda (MD): National Institutes of Health (NIH); 2007. 203 p. (NIH publication; no. 07-6225). [33 references] |
| Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients' fear of being labeled 'difficult' among key obstacles to shared decision making. Health Aff (Millwood). 2012 May;31(5):1030-8. PubMed |
| Gramling R, Stanek S, Ladwig S, Gajary-Coots E, Cimino J, Anderson W, Norton SA, AAHPM Research Committee Writing Group. Feeling heard and understood: a patient-reported quality measure for the inpatient palliative care setting. J Pain Symptom Manage. 2016 Feb;51(2):150-4. [20 references] PubMed |
| Houmann LJ, Chochinov HM, Kristjanson LJ, Petersen MA, Groenvold M. A prospective evaluation of dignity therapy in advanced cancer patients admitted to palliative care. Palliat Med. 2014 May;28(5):448-58. PubMed |
| Institute of Medicine (IOM). Dying in America: improving quality and honoring individual preferences near end-of-life. Washington (DC): The National Academies Press; 2015. 612 p. |
| Norton SA, Tilden VP, Tolle SW, Nelson CA, Eggman ST. Life support withdrawal: communication and conflict. Am J Crit Care. 2003 Nov;12(6):548-55. PubMed |
Primary Health Components
Palliative care; inpatient consultation; feeling heard and understood
Denominator Description
Number of hospitalized patients who received an initial consult visit by specialty palliative care between 24 and 72 hours prior to the time of item administration (see the related "Denominator Inclusions/Exclusions" field)
Numerator Description
- Option A ("At Goal"): Number of respondents who endorse "Completely"
- Option B ("At or Near Goal"): Number of respondents who endorse either "Completely" or "Quite a Bit"
Evidence Supporting the Measure
Type of Evidence Supporting the Criterion of Quality for the Measure
- One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
Additional Information Supporting Need for the Measure
Unspecified
Extent of Measure Testing
Unspecified
State of Use of the Measure
Application of the Measure in its Current Use
Measurement Setting
Hospital Inpatient
Professionals Involved in Delivery of Health Services
Advanced Practice Nurses
Allied Health Personnel
Nurses
Physician Assistants
Physicians
Least Aggregated Level of Services Delivery Addressed
Single Health Care Delivery or Public Health Organizations
Statement of Acceptable Minimum Sample Size
Unspecified
Target Population Age
Unspecified
Target Population Gender
Either male or female
National Strategy for Quality Improvement in Health Care
National Quality Strategy Aim
Better Care
National Quality Strategy Priority
Person- and Family-centered Care
Institute of Medicine (IOM) National Health Care Quality Report Categories
Data Collection for the Measure
Case Finding Period
Unspecified
Denominator Sampling Frame
Patients associated with provider
Denominator (Index) Event or Characteristic
Institutionalization
Therapeutic Intervention
Denominator Time Window
Does not apply to this measure
Denominator Inclusions/Exclusions
Inclusions
Number of hospitalized patients who received an initial* consult visit by specialty palliative care between 24 and 72 hours prior to the time of item administration
Number of hospitalized patients who received an initial* consult visit by specialty palliative care between 24 and 72 hours prior to the time of item administration
*Initial refers to the first palliative care consult during this admission.
Exclusions
Unspecified
Unspecified
Exclusions/Exceptions
Does not apply to this measure
Numerator Inclusions/Exclusions
Inclusions
- Option A ("At Goal"): Number of respondents who endorse "Completely"
- Option B ("At or Near Goal"): Number of respondents who endorse either "Completely" or "Quite a Bit"
Exclusions
Unspecified
Unspecified
Numerator Search Strategy
Fixed time period or point in time
Data Source
Patient/Individual survey
Type of Health State
Does not apply to this measure
Instruments Used and/or Associated with the Measure
Heard & Understood Item
Computation of the Measure
Measure Specifies Disaggregation
Does not apply to this measure
Scoring
Dichotomous
Frequency Distribution
Rate/Proportion
Interpretation of Score
Desired value is a higher score
Allowance for Patient or Population Factors
Unspecified
Standard of Comparison
Internal time comparison
Identifying Information
Original Title
Heard & understood item.
Submitter
Gramling, Robert, MD, DSc, University of Vermont
Developer
Gramling, Robert, MD, DSc, University of Vermont
Funding Source(s)
This work was funded by a Research Scholar Grant from the American Cancer Society (Principal Investigator: R. Gramling).
Composition of the Group that Developed the Measure
- Robert Gramling, MD, DSc, University of Vermont (principal)
- Elizabeth Gajary-Coots, MA, RN, University of Rochester
- Susan Stanek, RN, University of Rochester
- Nathalie Dugoud, MSN, University of Rochester
- Heather Pyke, MS, University of Rochester
- Marie Thomas, BA, University of Rochester
- Jenica Cimino, BA, University of California San Francisco
- Mechelle Sanders, MPH, University of Rochester
- Stewart C. Alexander, PhD, Purdue University
- Ronald Epstein, MD, University of Rochester
- Kevin Fiscella, MD, MPH, University of Rochester
- David Gramling, PhD, University of Arizona
- Susan Ladwig, MPH, University of Rochester
- Wendy Anderson, MD, MS, University of California San Francisco
- Sally A. Norton, PhD, RN, University of Rochester
Financial Disclosures/Other Potential Conflicts of Interest
None
Adaptation
This measure was not adapted from another source.
Date of Most Current Version in NQMC
2016 Feb
Measure Maintenance
Updated annually
Date of Next Anticipated Revision
2018 Jan
Measure Status
This is the current release of the measure.
Source(s)
| Gramling R, Stanek S, Ladwig S, Gajary-Coots E, Cimino J, Anderson W, Norton SA, AAHPM Research Committee Writing Group. Feeling heard and understood: a patient-reported quality measure for the inpatient palliative care setting. J Pain Symptom Manage. 2016 Feb;51(2):150-4. [20 references] PubMed |
Measure Availability
Source available for purchase from the Elsevier Web site .
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For more information, contact Robert Gramling, MD, DSc, at the University of Vermont College of Medicine, 235 Rowell, 106 Carrigan Drive, Burlington, VT 05405; Phone: (802) 847-4848; E-mail: Robert.Gramling@uvm.edu.
NQMC Status
This NQMC measure summary was completed by ECRI Institute on September 28, 2016. The information was verified by the measure developer on October 3, 2016.
Copyright Statement
This article was published in the Journal of Pain and Symptom Management, Vol. 51, Gramling R, Stanek S, Ladwig S, Gajary-Coots E, Cimino J, Anderson W, Norton SA, AAHPM Research Committee Writing Group, Feeling heard and understood: a patient-reported quality measure for the inpatient palliative care setting, 150-4, Copyright Elsevier (2016). This permission is granted for non-exclusive world rights in all languages. Reproduction of this material is granted for the purpose for which permission is hereby given, and includes use in any future editions.
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