As efforts to improve end-of-life care have increased, policymakers and administrators have sought quality measures to evaluate clinicians’ and hospitals’ performance. These efforts are a critical step toward achieving lasting and widespread improvements in care near the end of life.

Quality measures influence policy and practice by serving as the basis for public reporting, reimbursement, and accreditation. In addition, quality metrics endorsed by authoritative organizations carry normative weight: they influence how people define good (and bad) medical care. Therefore, quality measures should be based on strong clinical evidence and should be tightly linked to outcomes that are important to patients or society. Resource allocation considerations may also be relevant in formulating end-of-life quality metrics. However, there is considerable controversy on this point and a detailed discussion is beyond the scope of this commentary.

One metric that has been proposed as a...

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