Palliative Care Integration Project (PCIP) Quality Improvement Strategy Evaluation

Abstract

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.

Symptom burden and performance status in a population‐based cohort of ambulatory cancer patients

“…The province-wide initiative to standardize symptom and performance status assessments was modeled on a successful pilot project, 9,10 which suggested that routine use of these tools decreased emergency department visits, hospital admissions, and in-hospital deaths. 10 Details of the nature of the provincial initiative have been described elsewhere.…”

“…The province-wide initiative to standardize symptom and performance status assessments was modeled on a successful pilot project, 9,10 which suggested that routine use of these tools decreased emergency department visits, hospital admissions, and in-hospital deaths. 10 Details of the nature of the provincial initiative have been described elsewhere. 9,10 Briefly, the initiative's goal is to improve symptom management and collaborative palliative care planning through earlier identification, documentation, and communication of patients' symptoms and performance status.…”

“…10 Details of the nature of the provincial initiative have been described elsewhere. 9,10 Briefly, the initiative's goal is to improve symptom management and collaborative palliative care planning through earlier identification, documentation, and communication of patients' symptoms and performance status. In 2008, about 45% of the lung cancer population and 15% of the remaining cancer patients in Ontario were screened, 11 and patient capture is increasing.…”

“…Its validity and reliability are well described. [16][17][18] Previous research has categorized the severity of ESAS scores as none (0), mild (1-3), moderate (4)(5)(6), and severe (7)(8)(9)(10). 19 These scores were reported by the patient at the time of their visit to a cancer center or at the time of a visit from a home-care nurse.…”

The Importance of Evaluating Symptoms and Functional Alterations in Chronic Neurological Diseases: Experiences in Palliative Care and Rehabilitation at a Colombian Institution

“…Entre los síntomas que pueden incrementar la carga de los cuidadores se encuentran alteraciones de la memoria, que se presentó en 38%; alteraciones en la independencia para realizar las actividades bási-cas cotidianas en 29%, y de la vida diaria 21,2%; trastornos del sueño en 16%, y alteraciones comportamentales en 15%. Futuros estudios deberían medir la carga del cuidado con instrumentos validados en nuestro idioma para conocer el impacto de los programas multidisciplinarios en la atención de estos pacientes, como ha sido reportado en otras lenguas (36,37). Este aspecto proporciona nuevas perspectivas para estudiar en el futuro en relación con el cuidado paliativo y la rehabilitación en pacientes no oncológicos.…”