Surveying Family Caregivers to Assess Quality of End-of-Life Care in Medicare Advantage

<b><i>Objectives:</i></b> As Medicare Advantage (MA) enrollment increases, measures are needed to monitor end-of-life care quality across settings. We aimed to use MA data to identify respondents for a survey of end-of-life care and derive quality measures from survey responses. <b><i>Study Design:</i></b> Cross-sectional study. <b><i>Methods:</i></b> We developed a survey that assesses end-of-life care experiences across settings and field-tested it among family caregivers of Kaiser Permanente members who died from July to November 2021. We used factor analysis to assess survey item performance and calculate composite measures, examined validity by regressing overall ratings on composites, and described care experiences across settings and care patterns through multivariable regression. <b><i>Results:</i></b> The response rate was 30%; 33% of decedents had cancer, 49% died at home, 24% in a hospital, and 5% in a nursing home. Confirmatory factor analyses supported five composite quality measures, assessing timeliness, communication, consistency of care with patient preferences, respect, and symptom palliation. Cronbach's alpha indicated adequate internal consistency reliability of composites (range: 0.72-0.82). Care experiences were better for those who died at home with hospice compared with those who died in a nursing home and for those who received care from one setting compared with those who transitioned across settings. <b><i>Conclusion:</i></b> It is possible to sample family caregivers for a survey of end-of-life care experiences using administrative data from an MA organization. Survey-based quality measures can be used to assess and compare the quality of end-of-life care in MA.