Evaluating a hospice program: a practical approach.

The rapid growth of hospice care in this country has precipitated a need for ensuring quality through administrative program evaluation. Over the past few years a number of studies have been undertaken to evaluate the effects ofhospice care in relation to cost effectiveness, benefit, and utility. The question, "Is hospice effective?" is being examined by hospice administrators and researchers. These investigators are beginning to explore what kinds of terminal care interventions, by whom, and in what combinations, work best for particular hospice patients and their families under a specific set of circumstances.1 Studies like the New Haven and St. Christopher's Hospice evaluation have utilized self report questionnaires obtained from patients or their spouses to assess phenomena such as depression, anxiety, and pain in reponse to hospice care interventions.3A4 Other comprehensive evaluations have been attempted through the review of patient records, and personal interviews with staff and families of deceased hospice patients. 5,6 There is a growing need for data that addresses overall hospice program services from a recipient or family perspective. The federal government has identified specific evaluation criteria for hospices choosing to participate in the hospice Medicare benefit. According to the Hospice Conditions of Participation: "It is anticipated that critiques by patients' families provide a useful means to measure the degree to which patients' symptoms were managed." 7 Certainly, program evaluation is desirable and necessary. However, few hospices in this country have the expert knowledge needed to develop complex research designs and methodologies