Palliative Care Integration Project (PCIP) Quality Improvement Strategy Evaluation

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• 作者：Deborah J. Dudgeon ; Christine Knott ; Mary Eichholz ; Jacqueline Lochhaas Gerlach ; Cheryl Chapman ; Raymond Viola ; Janice Van Dijk ; Sharon Preston ; Diane Batchelor ; Emma Bartfay
• 关键词：Palliative care ; cancer ; symptom management ; evidence based ; collaborative care plans (CCPs) ; health services ; health system integration ; program evaluation
• 刊名：Journal of Pain and Symptom Management
• 出版年：2008
• 出版时间：June 2008
• 年：2008
• 卷：35
• 期：6
• 页码：573-582
• 全文大小：422 K

文摘

This study evaluated the effectiveness of implementation of common assessment tools, collaborative care plans, and symptom management guidelines for cancer patients as a strategy to improve the quality, coordination, and integration of palliative care service across organizations and health care sectors. A pre-post design to measure the impact on symptom management, caregiver burden and satisfaction with care delivery, and service utilization was used. Two cohorts of eligible patients and caregivers completed Edmonton Symptom Assessment Scales, Caregiver Reaction Assessment and FAMCARE Scales and chart audits were conducted. Administrative data from each participating site were examined for utilization trends. Audits of 53 charts preimplementation and 63 postimplementation showed an increase in documentation of pain from 24.5 % to 74.6 % (P < 0.001) of charts. Administrative data showed a decrease in the percentage of patients with at least one emergency room visit from 94.3 % to 84.8 % (P < 0.001), in the percentage of patients with at least one admission to the acute care hospital (P < 0.001), and deaths in acute care 43.1 % –35.7 % (P = 0.133). There was minimal change in the intensity of symptoms (P = 0.591), and no change in the burden on the caregiver (P = 0.086) or caregiver satisfaction with care (P = 0.942). This study showed that implementation of common assessment tools, collaborative care plans, and symptom management guidelines across health sectors can result in some increased documentation of symptoms and efficiencies in care. Future projects should consider imbedding a continuous quality improvement methodology and longer timelines into their projects to improve outcomes.