In the future, with experience with the measures, development of guidelines, and research, the use of these measurements will be extended to informing the consumer and purchasers of health care. Such measures must incorporate both the patient and family perspective on the quality of care at the end of life. The medical record review of people who have died is another important perspective on medical care at the end of life. We urge rapid cycles of improvement in measurement. The first Toolkit should quickly become outdated with research and further development of guidelines.
Research is needed to understand who can best serve as the respondent.
Such research is needed to design valid instruments. Each have their own costs and limitations regarding accuracy of the data. Research ought to seek to determine the most cost effective means to get reliable and valid indicators of quality medical care. Research is needed to examine the degree to which the wording and the location of questions influence the respondents' views. Total survey design that employs cognitive interviews is important to understand the process undertaken by espondents in answering survey questions.