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Article: Evaluation of a continuous quality improvement initiative for end-of- life care for older noncancer patients
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TitleEvaluation of a continuous quality improvement initiative for end-of- life care for older noncancer patients
 
AuthorsWoo, J2
Cheng, JOY2
Lee, J2
Lo, R2
Hui, E2
Lum, CM2
Or, KH2
Yeung, F2
Wong, F2
Mak, B1
 
Issue Date2011
 
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jmda
 
CitationJournal of the American Medical Directors Association, 2011, v. 12 n. 2, p. 105-113 [How to Cite?]
DOI: http://dx.doi.org/10.1016/j.jamda.2010.02.011
 
AbstractOBJECTIVES: The burden of suffering among patients with end-stage chronic diseases may be greater than those of cancer patients, as a result of longer duration of illness trajectory and high prevalence of symptoms, yet they may be less likely to receive palliative care services. To improve the quality of care of these patients, we carried out a continuous quality improvement initiative among medical and nursing staff of a convalescent facility. DESIGN: Evaluation of a quality improvement initiative. SETTING: Nonacute institution in Hong Kong SAR, China. PARTICIPANTS: The participants were patients with advanced chronic diseases not opting for active treatment. INTERVENTION: The intervention was a continuous quality improvement process carried out over a 3-month period, consisting of service reengineering, provision of guidelines and educational material, and interactive sessions to achieve culture change among staff. Evaluation before and after the intervention included patient symptoms checklist and quality-of-life measures for patients; quality-of-life and cost-of-care index for family members; quality-of-life and carer burden for staff; and use of various health care services. RESULTS: There were 80 and 89 participants in the pre- and post-intervention phase. The initiative resulted in shorter duration of stay, fewer investigations, fewer transfers back to the affiliated acute care hospital, and more follow-up by the outreach team, with no significant difference in mortality after adjusting for age and comorbidity. Symptoms of pain and cough were reduced, while there was a trend toward more constipation but less dizziness. Family members' satisfaction improved. CONCLUSIONS: It is possible to improve quality-of-life care for elderly patients with end-stage chronic diseases by staff education, and culture and system change, not only without additional resources, but likely savings were achieved in terms of reduced use of health care resources.
 
DescriptionComment in J Am Med Dir Assoc. 2011 Feb;12(2):86-87
 
ISSN1525-8610
2012 Impact Factor: 5.302
2012 SCImago Journal Rankings: 0.841
 
DOIhttp://dx.doi.org/10.1016/j.jamda.2010.02.011
 
ISI Accession Number IDWOS:000287331500007
Funding AgencyGrant Number
Hong Kong Jockey Club Charities Foundation
Funding Information:

This study was supported by the Hong Kong Jockey Club Charities Foundation Cadenza Project.

 
DC FieldValue
dc.contributor.authorWoo, J
 
dc.contributor.authorCheng, JOY
 
dc.contributor.authorLee, J
 
dc.contributor.authorLo, R
 
dc.contributor.authorHui, E
 
dc.contributor.authorLum, CM
 
dc.contributor.authorOr, KH
 
dc.contributor.authorYeung, F
 
dc.contributor.authorWong, F
 
dc.contributor.authorMak, B
 
dc.date.accessioned2011-09-23T06:23:59Z
 
dc.date.available2011-09-23T06:23:59Z
 
dc.date.issued2011
 
dc.description.abstractOBJECTIVES: The burden of suffering among patients with end-stage chronic diseases may be greater than those of cancer patients, as a result of longer duration of illness trajectory and high prevalence of symptoms, yet they may be less likely to receive palliative care services. To improve the quality of care of these patients, we carried out a continuous quality improvement initiative among medical and nursing staff of a convalescent facility. DESIGN: Evaluation of a quality improvement initiative. SETTING: Nonacute institution in Hong Kong SAR, China. PARTICIPANTS: The participants were patients with advanced chronic diseases not opting for active treatment. INTERVENTION: The intervention was a continuous quality improvement process carried out over a 3-month period, consisting of service reengineering, provision of guidelines and educational material, and interactive sessions to achieve culture change among staff. Evaluation before and after the intervention included patient symptoms checklist and quality-of-life measures for patients; quality-of-life and cost-of-care index for family members; quality-of-life and carer burden for staff; and use of various health care services. RESULTS: There were 80 and 89 participants in the pre- and post-intervention phase. The initiative resulted in shorter duration of stay, fewer investigations, fewer transfers back to the affiliated acute care hospital, and more follow-up by the outreach team, with no significant difference in mortality after adjusting for age and comorbidity. Symptoms of pain and cough were reduced, while there was a trend toward more constipation but less dizziness. Family members' satisfaction improved. CONCLUSIONS: It is possible to improve quality-of-life care for elderly patients with end-stage chronic diseases by staff education, and culture and system change, not only without additional resources, but likely savings were achieved in terms of reduced use of health care resources.
 
dc.description.natureLink_to_subscribed_fulltext
 
dc.descriptionComment in J Am Med Dir Assoc. 2011 Feb;12(2):86-87
 
dc.identifier.citationJournal of the American Medical Directors Association, 2011, v. 12 n. 2, p. 105-113 [How to Cite?]
DOI: http://dx.doi.org/10.1016/j.jamda.2010.02.011
 
dc.identifier.doihttp://dx.doi.org/10.1016/j.jamda.2010.02.011
 
dc.identifier.epage113
 
dc.identifier.hkuros192272
 
dc.identifier.isiWOS:000287331500007
Funding AgencyGrant Number
Hong Kong Jockey Club Charities Foundation
Funding Information:

This study was supported by the Hong Kong Jockey Club Charities Foundation Cadenza Project.

 
dc.identifier.issn1525-8610
2012 Impact Factor: 5.302
2012 SCImago Journal Rankings: 0.841
 
dc.identifier.issue2
 
dc.identifier.pmid21266286
 
dc.identifier.scopuseid_2-s2.0-78751696081
 
dc.identifier.spage105
 
dc.identifier.urihttp://hdl.handle.net/10722/141036
 
dc.identifier.volume12
 
dc.languageeng
 
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jmda
 
dc.publisher.placeUnited States
 
dc.relation.ispartofJournal of the American Medical Directors Association
 
dc.subject.meshAged
 
dc.subject.meshHong Kong
 
dc.subject.meshQuestionnaires
 
dc.subject.meshTerminal Care - standards
 
dc.subject.meshTotal Quality Management
 
dc.titleEvaluation of a continuous quality improvement initiative for end-of- life care for older noncancer patients
 
dc.typeArticle
 
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<contributor.author>Cheng, JOY</contributor.author>
<contributor.author>Lee, J</contributor.author>
<contributor.author>Lo, R</contributor.author>
<contributor.author>Hui, E</contributor.author>
<contributor.author>Lum, CM</contributor.author>
<contributor.author>Or, KH</contributor.author>
<contributor.author>Yeung, F</contributor.author>
<contributor.author>Wong, F</contributor.author>
<contributor.author>Mak, B</contributor.author>
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<date.available>2011-09-23T06:23:59Z</date.available>
<date.issued>2011</date.issued>
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<description>Comment in J Am Med Dir Assoc. 2011 Feb;12(2):86-87</description>
<description.abstract>OBJECTIVES: The burden of suffering among patients with end-stage chronic diseases may be greater than those of cancer patients, as a result of longer duration of illness trajectory and high prevalence of symptoms, yet they may be less likely to receive palliative care services. To improve the quality of care of these patients, we carried out a continuous quality improvement initiative among medical and nursing staff of a convalescent facility. DESIGN: Evaluation of a quality improvement initiative. SETTING: Nonacute institution in Hong Kong SAR, China. PARTICIPANTS: The participants were patients with advanced chronic diseases not opting for active treatment. INTERVENTION: The intervention was a continuous quality improvement process carried out over a 3-month period, consisting of service reengineering, provision of guidelines and educational material, and interactive sessions to achieve culture change among staff. Evaluation before and after the intervention included patient symptoms checklist and quality-of-life measures for patients; quality-of-life and cost-of-care index for family members; quality-of-life and carer burden for staff; and use of various health care services. RESULTS: There were 80 and 89 participants in the pre- and post-intervention phase. The initiative resulted in shorter duration of stay, fewer investigations, fewer transfers back to the affiliated acute care hospital, and more follow-up by the outreach team, with no significant difference in mortality after adjusting for age and comorbidity. Symptoms of pain and cough were reduced, while there was a trend toward more constipation but less dizziness. Family members&apos; satisfaction improved. CONCLUSIONS: It is possible to improve quality-of-life care for elderly patients with end-stage chronic diseases by staff education, and culture and system change, not only without additional resources, but likely savings were achieved in terms of reduced use of health care resources.</description.abstract>
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Author Affiliations
  1. The University of Hong Kong
  2. Chinese University of Hong Kong