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Improving palliative care in selected settings in England using quality indicators: a realist evaluation

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 pallia...

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Autores principales: Iliffe, Steve, Davies, Nathan, Manthorpe, Jill, Crome, Peter, Ahmedzai, Sam H, Vernooij-Dassen, Myrra, Engels, Yvonne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970274/
https://www.ncbi.nlm.nih.gov/pubmed/27484414
http://dx.doi.org/10.1186/s12904-016-0144-1
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author Iliffe, Steve
Davies, Nathan
Manthorpe, Jill
Crome, Peter
Ahmedzai, Sam H
Vernooij-Dassen, Myrra
Engels, Yvonne
author_facet Iliffe, Steve
Davies, Nathan
Manthorpe, Jill
Crome, Peter
Ahmedzai, Sam H
Vernooij-Dassen, Myrra
Engels, Yvonne
author_sort Iliffe, Steve
collection PubMed
description 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.
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spelling pubmed-49702742016-08-03 Improving palliative care in selected settings in England using quality indicators: a realist evaluation Iliffe, Steve Davies, Nathan Manthorpe, Jill Crome, Peter Ahmedzai, Sam H Vernooij-Dassen, Myrra Engels, Yvonne BMC Palliat Care Research Article 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. BioMed Central 2016-08-02 /pmc/articles/PMC4970274/ /pubmed/27484414 http://dx.doi.org/10.1186/s12904-016-0144-1 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Iliffe, Steve
Davies, Nathan
Manthorpe, Jill
Crome, Peter
Ahmedzai, Sam H
Vernooij-Dassen, Myrra
Engels, Yvonne
Improving palliative care in selected settings in England using quality indicators: a realist evaluation
title Improving palliative care in selected settings in England using quality indicators: a realist evaluation
title_full Improving palliative care in selected settings in England using quality indicators: a realist evaluation
title_fullStr Improving palliative care in selected settings in England using quality indicators: a realist evaluation
title_full_unstemmed Improving palliative care in selected settings in England using quality indicators: a realist evaluation
title_short Improving palliative care in selected settings in England using quality indicators: a realist evaluation
title_sort improving palliative care in selected settings in england using quality indicators: a realist evaluation
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970274/
https://www.ncbi.nlm.nih.gov/pubmed/27484414
http://dx.doi.org/10.1186/s12904-016-0144-1
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