Proposed quality measures for palliative care in the critically ill: A consensus from the Robert Wood Johnson foundation critical care workgroup

Richard A. Mularski, J. Randall Curtis, J. Andrew Billings, Robert Burt, Ira Byock, Cathy Fuhrman, Anne C. Mosenthal, Justine Medina, Daniel E. Ray, Gordon D. Rubenfeld, Lawrence J. Schneiderman, Patsy D. Treece, Robert D. Truog, Mitchell M. Levy

Research output: Contribution to journalArticlepeer-review

112 Scopus citations


For critically ill patients and their loved ones, high-quality health care includes the provision of excellent palliative care. To achieve this goal, the healthcare system needs to identify, measure, and report specific targets for quality palliative care for critically ill or injured patients. Our objective was to use a consensus process to develop a preliminary set of quality measures to assess palliative care in the critically ill.We built on earlier and ongoing efforts of the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup to propose specific measures of the structure and process of palliative care. We used an informal iterative consensus process to identify and refine a set of candidate quality measures. These candidate measures were developed by reviewing previous literature reviews, supplementing the evidence base with recently published systematic reviews and consensus statements, identifying existing indicators and measures, and adapting indicators from related fields for our objective. Among our primary sources, we identified existing measures from the Voluntary Hospital Association's Transformation of the ICU program and a government-sponsored systematic review performed by RAND Health to identify palliative care quality measures for cancer care.Our consensus group proposes 18 quality measures to assess the quality of palliative care for the critically ill and injured. A total of 14 of the proposed measures assess processes of care at the patient level, and four measures explore structural aspects of critical care delivery. Future research is needed to assess the relationship of these measures to desired health outcomes. Subsequent measure sets should also attempt to include outcome measures, such as patient or surrogate satisfaction, as the field develops the means to rigorously measure such outcomes. The proposed measures are intended to stimulate further discussion, testing, and refinement for quality of care measurement and enhancement.

Original languageEnglish (US)
Pages (from-to)S404-S411
JournalCritical care medicine
Issue number11 SUPPL.
StatePublished - Nov 2006

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine


  • Critical care
  • Dying
  • End-of-life care
  • Intensive care
  • Measures
  • Outcome and process assessment
  • Quality indicators
  • Quality of health care
  • Terminal care

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