Measurement of the quality of hospice care is challenging given the severity of illness of hospice patients; the rapid decline in their functional status and ability to report symptoms; the fact that they are receiving care in their homes, which generally means that a clinician is present only episodically to record symptoms or other outcomes of interest; and the fact that most hospices are relatively small, with correspondingly limited operating budgets. Lack of automation leads to laborious manual recording and aggregation of data for quality assurance purposes
