scholarly journals Improving Documentation of Distress in Veteran Patients for Hematology/Oncology Clinics

2019 ◽  
Vol 15 (5) ◽  
pp. e475-e479
Author(s):  
Samantha Bodner ◽  
Arpan Patel ◽  
Priya K. Gopalan
Keyword(s):  
Quality Improvement ◽  
Medical Records ◽  
Medical Center ◽  
Quality Improvement Intervention ◽  
Pdsa Cycle ◽  
Patients Experience ◽  
Cancer Network ◽  
Improvement Intervention

The purpose of this quality improvement study was to improve physician documentation of distress in medical records of hematology/oncology veteran patients at the Malcolm Randall Veteran Affairs (VA) Medical Center hematology/oncology fellows’ clinic in Gainesville, Florida. Before this intervention, the VA hematology/oncology fellows were not documenting patient distress in medical records. The quality improvement intervention was executed through the use of Plan-Do-Study-Act (PDSA) cycles with an ultimate goal of 50% documentation rate. Physician charts were audited to investigate official documentation of distress in patient charts. Physician documentation of distress was 14% in the first PDSA cycle, 21% in the second PDSA cycle, and 36% in the third PDSA cycle. Additional data on distress in hematology/oncology veteran patients were collected using the National Comprehensive Cancer Network Distress Thermometer and Problem List for Patients. Analysis of findings indicated that 42% of 88 patients experienced distress. Findings also suggest that hematology/oncology veteran patients experience specific sources of distress, notably fatigue and pain. These patients have presumably undergone unique experiences that can result in distress that providers should follow-up with in medical charts. Although this intervention has proven challenging to fully implement, standardizing patient distress in patient medical records has the potential to improve the quality of care provided by hematology/oncology physicians.

Anticancer therapy within the last 30 days of life: Results of an audit and re-audit cycle from a regional cancer center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18260-e18260
Author(s):  
Mike Nguyen ◽  
Alysson Wann ◽  
Babak Tamjid ◽  
Arvind Sahu ◽  
Javier Torres
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Retrospective Review ◽  
Medical Records ◽  
Quality Improvement Intervention ◽  
Separate Analysis ◽  
Number Of Patients ◽  
Audit Period ◽  
Improvement Intervention

e18260 Background: The therapeutic landscape in medical oncology continues to expand significantly. Newer therapies, especially immunotherapy, offer the hope of profound and durable responses with more tolerable side effect profiles. Integrating this information into the decision making process is challenging for patients and oncologists. Systemic anticancer treatment within the last thirty days of life is a key quality of care indicator and is one parameter used in the assessment of aggressiveness of care. Methods: A retrospective review of medical records of all patients previously treated at Goulburn Valley Health oncology department who died between 1 January 2015 and 30 June 2018 was conducted. Information collected related to patient demographics, diagnosis, treatment, and hospital care within the last 30 days of life. These results were presented to a hospital meeting and a quality improvement intervention program instituted. A second retrospective review of medical records of all patients who died between 1 July 2018 and 31 December 2018 was conducted in order to measure the effect of this intervention. Results: The initial audit period comprised 440 patients. 120 patients (27%) received treatment within the last 30 days of life. The re-audit period comprised 75 patients. 19 patients (25%) received treatment within the last 30 days of life. Treatment rates of chemotherapy reduced after the intervention in contrast to treatment rates of immunotherapy which increased. A separate analysis calculated the rate of mortality within 30 days of chemotherapy from the total number of patients who received chemotherapy was initially 8% and 2% in the re-audit period. Treatment within the last 30 days of life was associated with higher use of aggressive care such as emergency department presentation, hospitalisation, ICU admission and late hospice referral. Palliative care referral rates improved after the intervention. Conclusions: This audit demonstrated that a quality improvement intervention can impact quality of care indicators with reductions in the use of chemotherapy within the last 30 days of life. However, immunotherapy use increased which may be explained by increased access and perceived better tolerability.

A Multimodal Intervention to Reduce Urinary Catheter Use and Associated Infection at a Veterans Affairs Medical Center

2013 ◽  
Vol 34 (6) ◽  
pp. 631-633 ◽  
Author(s):  
Brady L. Miller ◽  
Sarah L. Krein ◽  
Karen E. Fowler ◽  
Karen Belanger ◽  
Debbie Zawol ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urinary Catheter ◽  
Medical Center ◽  
Veterans Affairs ◽  
Quality Improvement Intervention ◽  
Tract Infections ◽  
The Impact ◽  
Improvement Intervention

We assessed the impact of a quality improvement intervention to reduce urinary catheter use and associated urinary tract infections (UTIs) at a single hospital. After implementation, UTIs were reduced by 39% (P = .04). Additionally, we observed a slight decrease in catheter use and the number of catheters without an appropriate indication.

scholarly journals Did a quality improvement intervention improve quality of maternal health care? Implementation evaluation from a cluster-randomized controlled study

2019 ◽  
Vol 32 (1) ◽  
pp. 54-63 ◽  
Author(s):  
Elysia Larson ◽  
Godfrey M Mbaruku ◽  
Jessica Cohen ◽  
Margaret E Kruk
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Quality Improvement Intervention ◽  
Implementation Evaluation ◽  
Randomized Controlled ◽  
Cluster Randomized ◽  
Improvement Intervention

Abstract Objective To test the success of a maternal healthcare quality improvement intervention in actually improving quality. Design Cluster-randomized controlled study with implementation evaluation; we randomized 12 primary care facilities to receive a quality improvement intervention, while 12 facilities served as controls. Setting Four districts in rural Tanzania. Participants Health facilities (24), providers (70 at baseline; 119 at endline) and patients (784 at baseline; 886 at endline). Interventions In-service training, mentorship and supportive supervision and infrastructure support. Main outcome measures We measured fidelity with indictors of quality and compared quality between intervention and control facilities using difference-in-differences analysis. Results Quality of care was low at baseline: the average provider knowledge test score was 46.1% (range: 0–75%) and only 47.9% of women were very satisfied with delivery care. The intervention was associated with an increase in newborn counseling (β: 0.74, 95% CI: 0.13, 1.35) but no evidence of change across 17 additional indicators of quality. On average, facilities reached 39% implementation. Comparing facilities with the highest implementation of the intervention to control facilities again showed improvement on only one of the 18 quality indicators. Conclusions A multi-faceted quality improvement intervention resulted in no meaningful improvement in quality. Evidence suggests this is due to both failure to sustain a high-level of implementation and failure in theory: quality improvement interventions targeted at the clinic-level in primary care clinics with weak starting quality, including poor infrastructure and low provider competence, may not be effective.

Successful implementation of a quality improvement intervention towards a QOPI-compliant breast cancer center in Mexico.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 59-59
Author(s):  
Omar Peña-Curiel ◽  
Cynthia Villarreal-Garza ◽  
Mauricio Canavati-Marcos ◽  
Karen M. Velazquez-Ayala ◽  
Janeth Castro-Carrasco ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Improvement ◽  
Cancer Center ◽  
Quality Improvement Intervention ◽  
Successful Implementation ◽  
Microsoft Word ◽  
Pdsa Cycle ◽  
Oncology Practice ◽  
First Time

59 Background: Ensuring quality of care in our breast cancer center (BCC) at Hospital Zambrano Hellion in Monterrey, Mexico has been one of the main objectives since its commencement in 2016. To achieve this goal, we evaluated our compliance to ASCO’s Quality Oncology Practice Initiative (QOPI) 84 breast cancer related metrics as a part of a quality improvement (QI) project undertaken during the 2018 Quality Training Program (QTP) in Alexandria, VA. Methods: We established a multidisciplinary QI team engaged in data acquisition, process improvement and implementation in our BCC. We developed a Microsoft Word medical record template and established a new “first time visit” model to achieve our objective of 80% documentation rate of 13 identified reasonably achievable QOPI metrics. Monthly Plan-Do-Study-Act cycles were conducted for 6 months from August through December 2018. Results: After a sample data abstraction of 20 patients’ medical records, our baseline QOPI-compliance resulted in 40/84 QOPI metrics being met by our BCC program. The remaining 44/84 were distributed in two categories, the first 13/44 were labeled as “done/not documented” metrics, and the second set of 31/44 metrics were labeled as “not done/not documented” metrics given they were not performed at all. We approached the 13/44 “done/not documented” metrics for this project based on our priority matrix. After our QI intervention, we surpassed our objective by the third PDSA cycle. Furthermore, by March 2019 we reached 95% cumulative compliance of those metrics. Conclusions: The development of a systematic QI approach enhanced our BCC QOPI-compliance in 13 reasonably achievable metrics to 95% over a 6-month period. Currently, we are targeting the remaining 40/84 metrics to ultimately adhere to all breast cancer QOPI standards. To our knowledge, we are the first Mexican BCC pursuing a QOPI-compliant practice through ASCO’s QTP initiative.

scholarly journals Retention of HIV-Positive Adolescents in Care: A Quality Improvement Intervention in Mid-Western Uganda

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Jonathan Izudi ◽  
John Mugenyi ◽  
Mary Mugabekazi ◽  
Benjamin Muwanika ◽  
Victor Tumukunde Spector ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Intervention ◽  
Hiv Positive ◽  
Mobile Phone Technology ◽  
Fishbone Diagram ◽  
Context Specific ◽  
Western Uganda ◽  
Hiv Programs ◽  
Improvement Intervention

Background. Low retention of HIV-positive adolescents in care is a major problem across HIV programs. Approximately 70% of adolescents were nonretained in care at Katooke Health Center, Mid-Western Uganda. Consequently, a quality improvement (QI) project was started to increase retention from 29.3% in May 2016 to 90% in May 2017. Methods. In May 2016, we analyzed data for retention, prioritized gaps with theme-matrix selection, analyzed root causes with fishbone diagram, developed site-specific improvement changes and prioritized with countermeasures matrix, and implemented improvement changes with Plan-Do-Study-Act (PDSA). Identified root causes were missing follow-up strategy, stigma and discrimination, difficult health facility access, and missing scheduled appointments. Interventions tested included generating list of adolescents who missed scheduled appointments, use of mobile phone technology, and linkage of adolescents to nearest health facilities (PDSA 1), Adolescent Only Clinic (PDSA 2), and monthly meetings to address care and treatment challenges (PDSA 3). Results. Retention increased from 17 (29.3%) in May 2016 to 60 (96.7%) in August 2016 and was maintained above 90% until May 2017 (with exception of February and May 2017 recording 100% retention levels). Conclusion. Context specific, integrated, adolescent-centered interventions implemented using QI significantly improved retention in Mid-Western Uganda.

Sign in / Sign up

Export Citation Format

Share Document