Beyond the mortality metrics: A multidisciplinary approach to advancing high-value end-of-life care.

Abstract

618 Background: Healthcare is increasingly shifting toward value-based care models, which places increased pressure on health systems to deliver high-quality, goal-concordant care while reducing utilization at end of life (EOL). A well-structured multidisciplinary mortality review process can help identify opportunities to improve quality, patient experience, and healthcare value. This abstract describes a cancer service line (CSL) successfully implementing a multidisciplinary mortality review committee that drives accountability and quality improvement. Methods: We implemented a structured mortality review committee at a large urban teaching hospital with representatives from surgical, medical, and radiation oncology, and quality leadership from both the hospital and CSL. Cancer patients ≥18 years old, with all insurance types, and who died within 30 days of hospital admission were reviewed. The case reviewer evaluated and documented, in a shared workbook, whether the mortality was preventable, contributing factors to death, healthcare utilization, appropriateness of care, and goal concordance at EOL. The committee gathered monthly to present and discuss each case and arrive at a consensus to either recommend immediate escalation or aggregate for future QI. Results: From December 2024 through November 2025, 107 cases were reviewed. Mortalities were anticipated in 97.2% of cases. The opportunity to decrease healthcare utilization before death was seen in 76.64% of patients. Systemic cancer therapy ≤14 days before death was given to 7.48% of patients, 84.11% of patients had a goals of care conversation documented in an Advance Care Planning note in the EHR, and 73.83% of patients had a Palliative Medicine consult ≤90 days before death; however, notable patterns were identified around each of these metrics. Only 36.45% of patients were enrolled in hospice >3 days before death. The review process evolved over time with improvement in workbook, variable collection, and efficiency in distribution. Over time, the committee demonstrated a growing willingness to escalate concerns and apply critical analysis to both internal and external care teams, reflecting a strengthened culture of accountability. This progression was further supported by the integration of hospital quality leaders into the mortality committee, enhancing interdisciplinary collaboration, and overall quality improvement efforts. Conclusions: A multidisciplinary mortality review identified multiple opportunities to improve end-of-life care, particularly through early hospice enrollment and reduction of potentially avoidable healthcare utilization. The maturation of the mortality review committee—marked by increased escalation, critical analysis, and integration of quality leadership—demonstrates its growing impact as a driver of accountability and system-level quality improvement.