Quality Improvement in Cancer Symptom Assessment and Control: The Provincial Palliative Care Integration Project (PPCIP)

102 Background: Supportive care is under-addressed in oncology and an important area for quality improvement. Regular, directed feedback is an important component of effective quality management. What type of feedback yields the highest conformance to supportive care measures? Methods: Within the Carolinas Palliative Care Consortium, we conducted a series of three PDSA cycles, each one month-long, to evaluate various types of clinician-directed feedback on conformance to two supportive care measures. We collected data using a web-based, mobile health platform called QDACT-PC (Quality Data Collection Tool for Palliative Care). Every four weeks, feedback to clinicians on performance was changed in a stepwise fashion, from “no feedback” to “personal feedback” to “comparative feedback” (personal conformance compared to the rest of the Consortium). We monitored weekly changes to conformance to two quality measures: documentation of timely management of constipation and dyspnea. To meet the measures, symptoms with intensity of >3/10 on the Edmonton Symptom Assessment Scale required documentation of intervention within 24 hours. Conformance rates were calculated and compared to a historical baseline. Results: 23 providers participated in this quality improvement project, which spanned 465 patient encounters across 104 unique patients. Baseline data generated from 3/2008-10/2011 demonstrated baseline conformance to the dyspnea and constipation measures at 6% (27/457) and 4% (14/398), respectively. After addition of an electronic, prospective quality monitoring system alone (QDACT-PC), conformance increased to 93% (42/45) and 92% (23/25), respectively. With personalized, weekly feedback, these rates increased to 94% for dyspnea and 100% for constipation. Feedback comparing personal performance to the average of the rest of the Consortium further increased this to 100% for both. Conclusions: Regular, weekly feedback on performance increases conformance to supportive care quality measures. Adding comparative feedback versus other peers solidifies this effect. Duration of the effect is being evaluated.

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Palliating oncologists: A pilot study on primary palliative care development in hematology-oncology trainee outpatient clinics.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.21 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 21-21

Author(s):

Erin R. Alesi ◽

Sherri Rauenzahn ◽

Laurel Lyckholm

Keyword(s):

Palliative Care ◽

Intervention Group ◽

Symptom Burden ◽

Symptom Assessment ◽

Comfort Level ◽

Control Group ◽

Before And After ◽

And Control ◽

Short Answer Questions

21 Background: Primary Palliative Care (PPC) denotes basic PC competencies; whereas secondary PC (SPC) denotes consultant expertise. PPC competency includes basic symptom assessment/management; fundamental communication skills; and identification of patients for SPC. ASCO recommends early concurrent PC in advanced cancer/high symptom burden as it improves quality of life, symptom management, and care satisfaction. Because PC need exceeds availability of SPC providers, PPC proficiency by oncologists is essential. To enhance Hematology-Oncology (HO) fellows’ clinical experience through more effective PC training/utilization, we piloted an integrated fellows’ pre-clinic conference. Methods: HO fellows’ pre-clinic conferences were divided into intervention and control groups. Over 8 weeks, the PC fellow participated in interdisciplinary discussion for 2 weekly 1-hour conferences. The PC fellow provided PPC education via brief formal and informal didactics and identified patients for SPC referral. All HO fellows were surveyed before and after the intervention to assess comfort level with PPC and SPC referral. The survey used Likert-type scales and short-answer questions. Results: All HO fellows (N=10) voluntarily participated: 6 in the intervention group (IG), and 4 in the control group (CG). The IG demonstrated clearly enhanced comfort level with managing symptoms by improving in 100% of PPC categories after the intervention compared to 27% in the CG. Referral to SPC also increased in the IG, while it decreased in the CG. All HO fellows in the IG liked the PC integration, wanted to continue it, and wanted SPC availability in their future practice. Conclusions: This integration not only enhanced HO fellows’ PPC training and increased referral to SPC; it also fostered a partnership between HO and PC providers early in their careers. Such collaborative efforts are likely to improve long-term comprehensive cancer care as well as patient and provider satisfaction. Further study is merited and should include multiple centers and patient evaluations.

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Palliative Care in Medical Education at McMaster University

Journal of Palliative Care ◽

10.1177/082585978900500103 ◽

1989 ◽

Vol 5 (1) ◽

pp. 16-20 ◽

Cited By ~ 7

Author(s):

Fred I. Burge

Keyword(s):

Palliative Care ◽

Medical Education ◽

Ethical Issues ◽

Postgraduate Medical Education ◽

Symptom Assessment ◽

Current Approach ◽

Control Approach ◽

Philosophy Of Palliative Care ◽

Student Physician ◽

And Control

As professionals working within palliative care struggle to find their niche in the academic, administrative and service continuum of patient care, we have a growing desire to share what has been learned with students and colleagues. The opportunities for student physicians to learn the principles and practices of caring for the dying are few. The described curriculum content is dependent on the McMaster philosophy of medical education and the developmental level of the student physician. Areas included are: philosophy of palliative care, communication skills, symptom assessment and control, approach to ethical issues, decision making and interdisciplinary team function. The authors describe the university's current approach in its specific contribution to undergraduate and postgraduate medical education, the continuum throughout those years and an examination of recommendations for the future.

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Piloting A Self-Reported Symptom Assessment Tool In Three Outpatient Oncology Palliative Care Clinics

10.21203/rs.3.rs-284516/v2 ◽

2021 ◽

Author(s):

Mallikaben Bhanubhai Patel ◽

Ashley Leak Bryant ◽

Deborah K Mayer ◽

Gary Winzelberg

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Quality Improvement ◽

Symptom Assessment ◽

Comprehensive Cancer Center ◽

Staff Turnover ◽

Improvement Project ◽

Pdsa Cycle ◽

Edmonton Symptom Assessment Scale

Abstract Background: Palliative care outpatient clinics should assess patients’ symptoms and quality of life prior to visits to guide care and response to treatments. We describe the implementation of a quality improvement initiative to increase symptom and quality of life screening in the outpatient oncology palliative care (OOPC) clinics of one National Cancer Institute-designated Comprehensive Cancer Center. Method: Our quality improvement project structure was based on the RE-AIM framework. Guided by the Plan-Do-Study-Act (PDSA) approach, we focused on assessing effective implementation of the Edmonton Symptom Assessment Scale (ESAS-r ) and one Quality of Life (QoL) question at each OOPC visit. At the end of each 3-week PDSA cycle, barriers and facilitators were recognized and addressed. The implementation’s effectiveness was determined by percentage of adherence using the following formula: [(number of ESAS-r +1 QoL forms completed per clinic/Number of OOPC completed patient appointments per clinic) x 100].Results: A total of 372 patient appointments were completed during the four PDSA cycles, with overall 59% adherence. The first PDSA cycle compliance was 69%, 58% in the second, 52% in the third, and 65% at the last PDSA cycle. The primary barrier was staff turnover.Conclusion: We were able to implement the ESAS-r + 1 QoL form in a complex clinical outpatient setting. We identified barriers for sustainability, including staff turnover. We addressed these barriers by providing robust instructions that outlined an overview of the clinic workflow and education for all staff members involved in the implementation process. Based on our experience, we suggest integrating this form into the electronic medical record to monitor patient outcomes in the outpatient oncology clinics.

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Piloting a Self-Reported Symptom Assessment Tool in Three Outpatient Oncology Palliative Care Clinics

10.21203/rs.3.rs-284516/v1 ◽

2021 ◽

Author(s):

Mallikaben Bhanubhai Patel ◽

Ashley Leak Bryant ◽

Deborah K Mayer ◽

Gary Winzelberg

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Quality Improvement ◽

Symptom Assessment ◽

Comprehensive Cancer Center ◽

Staff Turnover ◽

Improvement Project ◽

Pdsa Cycle ◽

Edmonton Symptom Assessment Scale

Abstract Background: Palliative care outpatient clinics should assess patients’ symptoms and quality of life prior to visits to guide care and response to treatments. We describe the implementation of a quality improvement initiative to increase symptom and quality of life screening in the outpatient oncology palliative care (OOPC) clinics of one National Cancer Institute-designated Comprehensive Cancer Center. Method: Our quality improvement project structure was based on the RE-AIM framework. Guided by the Plan-Do-Study-Act (PDSA) approach, we focused on assessing effective implementation of the Edmonton Symptom Assessment Scale (ESAS-r ) and one Quality of Life (QoL) question at each OOPC visit. At the end of each 3-week PDSA cycle, barriers and facilitators were recognized and addressed. The implementation’s effectiveness was determined by percentage of adherence using the following formula: [(number of ESAS-r +1 QoL forms completed per clinic/Number of OOPC completed patient appointments per clinic) x 100].Results: A total of 372 patient appointments were completed during the four PDSA cycles, with overall 59% adherence. The first PDSA cycle compliance was 69%, 58% in the second, 52% in the third, and 65% at the last PDSA cycle. The primary barrier was staff turnover.Conclusion: We were able to implement the ESAS-r + 1 QoL form in a complex clinical outpatient setting. We identified barriers for sustainability, including staff turnover. We addressed these barriers by providing robust instructions that outlined an overview of the clinic workflow and education for all staff members involved in the implementation process. Based on our experience, we suggest integrating this form into the electronic medical record to monitor patient outcomes in the outpatient oncology clinics.

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Studi Kualitas Puding Melalui Pendekatan Six Sigma Studi Kasus Di Pt. Keong Nusantara Abadi

JURMATIS : Jurnal Ilmiah Mahasiswa Teknik Industri ◽

10.30737/jurmatis.v1i1.1009 ◽

2019 ◽

Vol 1 (1) ◽

pp. 44

Author(s):

Rony Trizudha ◽

Sri Rahayuningsih ◽

Ana Komari

Keyword(s):

Quality Control ◽

Quality Improvement ◽

Production Process ◽

Product Quality ◽

Six Sigma ◽

Improve Quality ◽

High Productivity ◽

Fierce Competition ◽

And Control ◽

Technology Advances

As technology advances at this time, players in business are aware of the importance of product quality in the increasingly fierce competition in the industrial world due to the emergence of many similar companies. Therefore, companies must be able to compete to meet customer desires and try to retain customers. To maintain customers and their marketing areas, companies must have high competitiveness in order to survive by prioritizing quality improvement, increasing efficiency and increasing productivity to improve quality because by increasing quality, products can be accepted among consumers so that company goals can be fulfilled. Therefore, the company must carry out effective quality control which will result in high productivity, lower overall cost of making goods and the factors that cause production failure to be minimized. To improve quality, use the six sigma method, DMAIC and seven tools so that it can be known the cause of the damage and what actions are taken so that there needs to be a controversy to stabilize the processes of the production process so that we can know what percentage of damage and what factors cause damage, therefore there must be measurements and recommendations for improvement and control to reduce the causes From the analysis, it was found that the dent cup was 20.36%, the lid was 21.36% less dense, the lid was damaged in the finished product 18.72%, the cup was 19.28% less thick, the packaging was flexible 20.55%Seiring kemajuan teknologi pada saat ini pelaku di bisnis menyadari akan pentingnya kualitas produk dalam persaingan dunia industri yang semakin ketat karena banyak bermunculan perusahaan-perusahaan sejenis. Oleh sebab itu perusahaan harus dapat bersaing untuk memenuhi keinginan pelanggan dan berusaha dapat mempertahankan pelanggan. Untuk mempertahankan pelangan dan wilayah pemasaranya perusahaan-perusahaan harus mempunyai daya saing yang tinggi untuk dapat bertahan dengan mengutamakan peningkatan mutu, peningkatan efisiensi dan peningkatan produktivitas untuk meningkatkan kualitas karena dengan peningkatan kualitas, produk dapat diterima di kalangan konsumen sehingga tujuan perusahaan dapat terpenuhi. Maka dari itu perusahaan harus melakukan pengendalian kualitas yang efektif akan menghasilkan produktivitas yang tinggi, biaya pembuatan barang keseluruhan yang lebih rendah serta faktor-faktor yang menyebabkan kegagalan produksi akan dapat ditekan sekecil mungkin. Untuk meningkatkan kualitas mengunakan metode six sigma, DMAIC dan seven tools agar dapat diketahui penyebab kerusakan dan tindakan apa saja yang dilakukan sehingga perlu ada kontror untuk menstabilkan peoses proses produksi sehinga dapat di ketahui berapa persen kerusakan dan faktor-faktor apa saja yang menyebabkan kerusakan maka dari itu harus ada pengukuran dan rekomendasi perbaikan serta melakukan kontrol untuk mengurangi penyebab kerusakan. Dari hasil analisis di ketahui cup penyok 20,36%, lid kurang rapat 21,36%, lid rusak pada produk jadi 18,72%,cup kurang tebal 19,28 %kemasan lentur 20,55%

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