Center for Health Equity Research and Promotion
FAQs about PROMISE
What is PROMISE?
PROMISE (Performance Reporting and Outcomes Measurement to Improve the Standard of care at End-of-life) is a center supported by the VA's Comprehensive End-of-Life Care Initiative. Its goals are:
- To identify and reduce unwanted variation in the quality of end-of-life care throughout the VA; and
- To define and disseminate processes of care (“Best Practices”) that contribute to improved outcomes for Veterans near the end of life and their families.
What does PROMISE do?
The principal activities of the PROMISE center include collecting and tracking data about outcomes of care (via the Bereaved Family Survey) based on staff who provide palliative care and hospice services at VA medical facilities and nursing homes.
What is the Bereaved Family Survey?
The Bereaved Family Survey (BFS) is a survey approved by the Office of Management and Budget (OMB) that provides data about families' perceptions of the care that the deceased Veterans received from VA inpatient facilities nationwide during the last month of life.
Who is the target population for the BFS?
The target population is all bereaved family members of Veterans who died as inpatients in any VA hospital nationwide.
Are PROMISE data available to researchers?
PROMISE is NOT a research study. PROMISE is a VA-based quality improvement project. However, since 2008 we have maintained a robust database containing variables encompassing Veterans’ clinical and demographic characteristics, process measures, and Bereaved Family Survey outcomes. Secondary analyses of these data have been conducted by a variety of VA-affiliated investigators. Use of PROMISE data requires approval by the PROMISE Center, IRB review, as well as a completed and approved Data Use/Transfer Agreement from VA Central Office. If you are interested in analyzing PROMISE Center data, please contact Meghan McDarby at Meghan.McDarby2@va.gov.
Is it possible for researchers to add questions to the BFS?
No. All questions in the PROMISE survey have been approved by the Office of Management and Budget. Items may not be added or modified without OMB permission.
Is it possible for any hospital to join PROMISE?
At this time, PROMISE is only open to VAMCs that participate as a Veterans Integrated Service Network (VISN) (all facilities in a VISN). PROMISE data contains Veteran-specific questions that may not be applicable or transferable to other patient populations.
How do we request data for a question we want to answer?
Email our Data Manager, Dawn Gilbert, with your questions: Dawn.Gilbert2@va.gov
Can we suggest wording changes to BFS questions?
No. The questions in the BFS survey have been through rigorous testing and have been approved by the Office of Management and Budget in the current form. Any changes to the BFS survey would require additional OMB approval.
Why was the wording changed from "doctors and other staff" to simply "staff" in the FY2013 BFS?
As a result of feedback from the field, PROMISE applied for OMB edit approval and changed the wording. The survey also now includes a clarifying statement about what staff includes. This statement reads: "Some of the questions ask about the staff. By staff, we mean doctors, nurses, social workers, chaplains, nursing assistants, therapists and other personnel."
How is the proposed benchmark for the BFS Performance Measure (BFS-PM) item calculated?
The performance measure represents the proportion of families who report that the Veteran received "excellent" care during the last month of life. The proposed benchmark for this item is calculated as the 20th percentile of facilities. This is the level that 80% of facilities exceed and 20% of facilities fall below. The proposed benchmark for the BFS-PM will be applied at the VISN level. Therefore, even though by definition 20% of facilities fall below this level, it is possible for all VISNs to exceed it.
How many surveys are necessary to draw meaningful conclusions about families’ perceptions?
The Office of Quality and Performance (OQP) recommends having at least 30 surveys from different families at a facility for valid measurement.
When are results released?
VISN Program Managers will receive quarterly reports from the PROMISE Center (released on January 1, April 1, July 1, and October 1). Informal data requests can be requested and sent at any time throughout the quarter.
Is it possible to get reports early (before the quarter is over)?
No. Since interviews are conducted six to eight weeks after the Veteran has died, it is not possible to receive a report before the quarter is over.
In PROMISE reports, how is Bereavement Contact defined?
The PROMISE Center defines a bereavement contact as any interaction (person to person) offering any type of emotional support that takes place between the time of death to two weeks after the Veteran’s death. Sending a bereavement packet is not considered an interaction.
In PROMISE reports, how is Chaplain Contact defined?
The PROMISE Center defines a chaplain contact as any interaction (person to person) with the Veteran or a family member involving spiritual support before the Veteran’s death. Contacts are coded separately for a Veteran and a family member.
Why are PROMISE’s palliative care consult numbers different from transformational measure numbers?
The transformational measure reports palliative consults completed or an admission to a TS-96 or 1-F bed in the last year of life for a patience. The PROMISE center looks back only 90 days instead of 365 days and accounts for the discrepancy between the two numbers. This change in time frame can assist in determining whether the timing of a palliative care consult has an effect on improving satisfaction at the end of life by providing an additional data point. The data provided by the PROMISE center on palliative consults is NOT used as a performance measure by VA Central Office. It is ONLY for diagnostic purposes.
How do PROMISE staff respond if they identify families with unmet needs?
The PROMISE staff offers family members the patient advocate phone number at the facility of the Veteran’s death for any financial or logistical needs. The Center also offers to contact the VISN Palliative Care Outcome Coordinator (PCOC) via a referral request for follow-up if the family member needs emotional support or has a complaint about the care received.
Is it possible to get national average scores?
Yes. Please contact the Data Manager, Dawn Gilbert (Dawn.Gilbert2@va.gov) for national average scores.
Why do you break down the qualitative data by site of death?
In the past other VISNs have requested the qualitative data be broken down by site of death. However, we are open to other suggestions for presenting the qualitative data.