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Improving palliative care in selected settings in England using quality indicators: a realist evaluation
- Source :
- BMC Palliative Care, 15, 69, BMC Palliative Care, BMC Palliative Care, 15, pp. 69, Iliffe, S, Davies, N, Manthorpe, J, Crome, P, Ahmedzai, S H, Vernooij-Dassen, M & Engels, Y 2016, ' Improving palliative care in selected settings in England using quality indicators : A realist evaluation ', BMC Palliative Care, vol. 15, no. 1, 69 . https://doi.org/10.1186/s12904-016-0144-1
- Publisher :
- Springer Nature
-
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.
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 1472684X
- Volume :
- 15
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC Palliative Care
- Accession number :
- edsair.doi.dedup.....96c64ef2a16b02664009231ea27f794d
- Full Text :
- https://doi.org/10.1186/s12904-016-0144-1