Survey Questions

Use the links below to review the National Palliative Care Registry™ survey questions for each care setting. You will also find definitions for key measures and detailed guidance for each survey question.

Starting January 1 2019, there will be new and improved surveys for hospital palliative care and home palliative care. Both are available below and contain an overview of the changes.

  • Hospital

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    Hospital Palliative Care Survey

    For palliative care programs that provide non-hospice palliative care services in hospitals (both consultation services and on inpatient palliative care units), Cancer Centers, or Long-Term Acute Care (LTAC) Facilities.
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    Starting January 1st 2019, we will be using a new version of the hospital survey. Find the new version of the hospital survey and an overview of the changes below.
    Download

  • Home

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    Home Palliative Care Survey

    For palliative care programs that provide non-hospice palliative care in patients’ homes, wherever they may live. “Home” includes residential homes, nursing homes, and other long-term care facilities.

    If your palliative care program is integrated into a long-term care facility and provides care to the entire residential population that lives there, please use the long-term care survey. If your program sees patients at long-term care facilities because that’s where the patients live, but does not provide care to the entire residential population, please include these palliative care patients in the home survey.

    Download

    Starting January 1st 2019, we will be using a new version of the home survey, informed by CAPC’s home palliative care workgroup. Find the new version of the home survey and an overview of the changes below.
    Download

  • Office/Clinic

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    Office/Clinic Palliative Care Survey

    For palliative care programs that provide non-hospice palliative care services at Clinics, Physician Offices, Federally Qualified Health Centers, End Stage Renal Disease (ESRD) Facilities, Outpatient Physical Therapy/Speech Pathology Facilities, Rural Health Clinics, Comprehensive Outpatient Rehabs, Ambulatory Surgical Centers or Community Mental Health Centers.

    *Only a shortened survey is available at this time.

    Download

  • Long-term Care

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    Long-term Care Palliative Care Survey

    For long-term care integrated palliative care programs that provide non-hospice palliative care services to Skilled Nursing Facilities (SNF), Nursing Homes, Rehab Facilities, or Assisted Living Facilities.

    If your palliative care program is integrated into a long-term care facility and provides care to the entire residential population that lives there, please use the long-term care survey. If your program sees patients at long-term care facilities because that’s where the patients live, but does not provide care to the entire residential population, please include these palliative care patients in the home survey.

    *Only a shortened survey is available at this time.

    Download