An evaluation of time and cost variability in hospice interdisciplinary group meetings and comparative clinical quality outcomes

This study involved a community-based, multisite hospice program serving 7 distinct communities in the greater Washington, DC, metropolitan area. The objectives were to compare time and costs among hospice interdisciplinary group (IDG) meetings and resultant select clinical outcomes in order to establish a benchmark for best practices within a large multisite hospice provider. A standardized data collection tool was used at all practice sites duringmultiple team meetings to determine staffing by discipline and numbers, types and number of patient reviews (new patients, patient deaths, simple vs complex plan-of-care revisions), time involved, resultant costs, and clinical key quality-of-care outcome measures, including pain relief, patient and family satisfaction, and crisis prevention and rates of disruptions in care (unscheduled medical visits, transfers to emergency departments and/or hospital). A point systemdevised by the authorswas used to normalize the data in order to account for differences in case mix (complexity, admissions, deaths). This novel approach has not been previously described, but was a necessary innovation in order to create apt comparisons among groups of patients and their respective interdisciplinary teams. Although all IDGs met Medicare Conditions of Participation standards, appreciable differences existed in all measured variables among the 7 community sites, leading to significant disparity in resultant costs associated with conducting IDG meetings across distinct communities served by this hospice agency. Significant increases in costs were not justified by commensurate improvements in clinical quality outcomes. In fact, the lowest-cost IDG also had as favorable or higher ratings on discrete clinical outcomemeasures as higher-cost IDGs. Weconclude that IDGs differ substantially in performance, and through a comparative analysis, an optimal model was discerned, comprising lowest overall costs without compromising quality of care.