4 results on '"Engels, Yvonne"'
Search Results
2. Improving palliative care in selected settings in England using quality indicators: a realist evaluation.
- Author
-
Iliffe, Steve, Davies, Nathan, Manthorpe, Jill, Crome, Peter, Ahmedzai, Sam H., Vernooij-Dassen, Myrra, and Engels, Yvonne
- Subjects
CANCER patients ,CLINICAL medicine ,DEMENTIA ,HOSPICE care ,NURSING specialties ,PALLIATIVE treatment ,QUALITY assurance ,HOSPICE nurses ,KEY performance indicators (Management) - Abstract
Background: There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England. Methods: 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service change in selected settings (general practice, community palliative care teams, care homes, hospital wards, in-patient hospices) with a before-and-after evaluation, and 3) realist evaluation of processes and outcomes across settings. Participants in each setting were supported to identify no more than three Quality Indicators to work on over an eight-month period in 2013/2014. Results: General practices could not be recruited to the study. Care homes were recruited but not retained. Hospital wards were recruited and retained, and using the Quality Indicator (QI) set achieved some of their desired changes. Hospices and community palliative care teams were able to use the QI set to achieve almost all their desired changes, and develop plans for quality improvements. Improvements included: increasing the utility of electronic medical records, writing a manual for end of life care, establishing working relationships with a hospice; standardising information transfer between settings, holding regular multi-disciplinary team meetings, exploration of family carers' views and experiences; developing referral criteria, and improvement of information transfer at patient discharge to home or to hospital. Realist evaluation suggested that: 1) uptake and use of QIs are determined by organisational orientation towards continuous improvement; 2) the perceived value of a QI package was not powerful enough for GPs and care homes to commit to or sustain involvement; 3) the QI set may have been to narrow in focus, or more specialist than generalist; and 4) the greater the settings''top-down' engagement with this change project, the more problematic was its implementation. Conclusions: Whilst use of QIs may facilitate improvements in specialist palliative care services, different QI sets may be needed for generalist care settings. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
3. Timely identification of palliative patients and anticipatory care planning by GPs: practical application of tools and a training programme.
- Author
-
Thoonsen, Bregje, Groot, Marieke, Verhagen, Stans, van Weel, Chris, Vissers, Kris, and Engels, Yvonne
- Subjects
CONTENT analysis ,EXPERIMENTAL design ,FOCUS groups ,GLOBAL Positioning System ,IDENTIFICATION ,INTERVIEWING ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL protocols ,PALLIATIVE treatment ,PATIENTS ,QUESTIONNAIRES ,RESEARCH evaluation ,STATISTICAL sampling ,STATISTICS ,TERMINAL care ,ADVANCE directives (Medical care) ,QUALITATIVE research ,DATA analysis ,THEMATIC analysis - Abstract
Background: Palliative care is mainly restricted to terminal care. General practitioners (GPs) are not trained to early identify palliative patients with cancer, COPD or heart failure. With the help of the RADboud indicators for PAlliative Care needs (RADPAC), we trained GPs to identify patients' needs and to make a proactive care plan. They were also able to join two role-plays where they discussed the patient's future, and consulted a palliative care consultant to fine-tune the care plan. We evaluated the programme with the GPs and consultants and noted its impact on their daily practice. Methods: Two years after they had participated in the programme, we held semi-structured interviews with the GPs and a focus group interview with the consultants and performed a thematic content analysis. Results: Six consultants and nine GPs participated in the programme. Most GPs and consultants mentioned positive changes in the thinking or acting of GPs regarding early palliative care. A number continued to use the tool to identify patients; most of the others noted they had internalised the indicators. Although half of them still considered discussing end-of-life aspects difficult, particularly in patients with organ failure, the others were more easily able to discuss the future with their palliative patients. Conclusion: Although most GPs and consultants were positive about the training programme and applying it in daily practice, we conclude that in future programmes, more attention needs to paid to timely identification of palliative patients with COPD or CHF and how to discuss the future with them. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
4. Improving palliative care in selected settings in England using quality indicators: a realist evaluation
- Author
-
Iliffe, Steve, Davies, Nathan, Manthorpe, Jill, Crome, Peter, Ahmedzai, Sam H, Vernooij-Dassen, Myrra, and Engels, Yvonne
- Subjects
Male ,Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1] ,Evidence-based practice ,Quality management ,Palliative care ,Referral ,Health Services for the Aged ,media_common.quotation_subject ,Best practice ,Care homes ,Quality indicators ,Patient Care Planning ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Electronic Health Records ,Humans ,Medicine ,Quality (business) ,030212 general & internal medicine ,Patient Comfort ,Quality improvement ,Quality Indicators, Health Care ,Quality of Health Care ,Cancer ,media_common ,Medicine(all) ,Terminal Care ,business.industry ,030503 health policy & services ,Medical record ,Hospices ,General Medicine ,Primary care ,3. Good health ,Hospitalization ,England ,Evidence-Based Practice ,Female ,Dementia ,0305 other medical science ,business ,Realist evaluation ,End-of-life care ,Research Article - Abstract
Background There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England. Methods 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service change in selected settings (general practice, community palliative care teams, care homes, hospital wards, in-patient hospices) with a before-and-after evaluation, and 3) realist evaluation of processes and outcomes across settings. Participants in each setting were supported to identify no more than three Quality Indicators to work on over an eight-month period in 2013/2014. Results General practices could not be recruited to the study. Care homes were recruited but not retained. Hospital wards were recruited and retained, and using the Quality Indicator (QI) set achieved some of their desired changes. Hospices and community palliative care teams were able to use the QI set to achieve almost all their desired changes, and develop plans for quality improvements. Improvements included: increasing the utility of electronic medical records, writing a manual for end of life care, establishing working relationships with a hospice; standardising information transfer between settings, holding regular multi-disciplinary team meetings, exploration of family carers’ views and experiences; developing referral criteria, and improvement of information transfer at patient discharge to home or to hospital. Realist evaluation suggested that: 1) uptake and use of QIs are determined by organisational orientation towards continuous improvement; 2) the perceived value of a QI package was not powerful enough for GPs and care homes to commit to or sustain involvement; 3) the QI set may have been to narrow in focus, or more specialist than generalist; and 4) the greater the settings’ ‘top-down’ engagement with this change project, the more problematic was its implementation. Conclusions Whilst use of QIs may facilitate improvements in specialist palliative care services, different QI sets may be needed for generalist care settings. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0144-1) contains supplementary material, which is available to authorized users.
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.