Hospice Clinicians' Approaches to Terminal Restlessness: A Qualitative Analysis.

Since 2016, Medicare has endorsed OP-35, a quality measure reporting potentially avoidable unplanned hospital visits (emergency department [ED] and inpatient admissions) that occur within 30 days of an outpatient chemotherapy administration. OP-35 is a diagnosis code–based definition of potentially avoidable hospital care for adults receiving chemotherapy and is incorporated into Medicare’s Enhancing Oncology Model alternative payment program, as well as the Medicare Hospital Outpatient Quality Reporting program, tying performance on this measure to financial incentives. The measure identifies diagnosis codes for 10 potentially avoidable conditions after chemotherapy such as nausea/vomiting, pain, and fever. Despite the widespread application of OP-35 in policy, practice, and the literature, including limitations in distinguishing brief hospital visits, this quality measure has not previously been clinically validated. Our goal was to compare this diagnosis code–based measure with clinician reviews of potentially avoidable hospital visits. We also developed and applied a more clinically descriptive taxonomy of hospital visits to provide an alternative method that is focused on actionable categories of hospital visits. We began with a population-based sample from 2 cancer-treating health systems across Dallas–Fort Worth, Texas: an academic medical center (University of Texas Southwestern Medical Center, or UT Southwestern) and its academically affiliated, but operationally distinct, county health system (Parkland Health, or Parkland).