Quality Indicators for Pain in Palliative Care

Measuring the quality of pain management is essential for demonstrating the value of providers’ efforts to control this burdensome symptom. Measuring pain management is also critical for developing and evaluating quality improvement initiatives in palliative care. Groups have recently developed quality indicators for pain management and tested them for feasibility, reliability, and validity in both cancer and general palliative care populations in various care settings. These indicators address structure, process, and outcomes throughout the spectrum of care. Measurement of pain management is facilitated by the availability of well-validated pain assessment tools. However, indicator implementation is limited by assessment challenges in vulnerable populations, inconsistent documentation of pain management aspects in the medical record, inaccessible relevant data in current electronic medical records (EMRs) and data sets, and lack of evidence for correlation between quality indicators and patient outcomes. We need further research for establishing pain indicators in children and patients who cannot report pain, tailoring pain measurement to different populations and settings, and improving integration of quality measurement into clinical care. We also need more development on indicators of nonphysical aspects of pain and its management. Last, we need to assess how pain management quality interacts with other palliative care symptoms and domains, as well as opioid misuse, a related important issue. The collection of patient-reported outcome data within routine clinical workflow and national/regional quality improvement collaborations establishing quality benchmarks have the potential to address some issues and improve the measurement as well as quality of pain management.