Defining and measuring quality palliative and end-of-life care in the intensive care unit

Quality of health care is primarily concerned with the provision of health services that intend to lead to valued health outcomes and are based and driven by evidence. Among other desired health outcomes are patient-and-family-centered values consistent with proficient palliative and end-of-life care in the intensive care unit. The research in palliative and end-of-life care has elucidated important domains for quality care-in general, major targets for improvement are known. However, assessment of quality at local and national levels remains relevant as innovators select where to begin quality improvement efforts and the healthcare system evaluates the efficacy and potential harm from care delivery transformations. In this article, I endeavor to impart a practical framework for quality of end-of-life care assessment with the goal of guiding the selection of initiatives and evaluating cycles of innovation. I will ground this quality evaluation by reviewing palliative and end-of-life care and the known domains for quality palliative care. Although the field has identified candidate indicators for evaluating palliative and end-of-life care in the intensive care unit, future work is needed to operationalize assessment for important aspects of care with valid, reliable, acceptable, efficient, and responsive measures.