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Article: Evaluation of a continuous quality improvement initiative for end-of- life care for older noncancer patients

TitleEvaluation of a continuous quality improvement initiative for end-of- life care for older noncancer patients
Authors
Issue Date2011
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jmda
Citation
Journal of the American Medical Directors Association, 2011, v. 12 n. 2, p. 105-113 How to Cite?
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
Persistent Identifierhttp://hdl.handle.net/10722/141036
ISSN
2014 Impact Factor: 4.939
2014 SCImago Journal Rankings: 1.263
ISI Accession Number ID
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 FieldValueLanguage
dc.contributor.authorWoo, Jen_US
dc.contributor.authorCheng, JOYen_US
dc.contributor.authorLee, Jen_US
dc.contributor.authorLo, Ren_US
dc.contributor.authorHui, Een_US
dc.contributor.authorLum, CMen_US
dc.contributor.authorOr, KHen_US
dc.contributor.authorYeung, Fen_US
dc.contributor.authorWong, Fen_US
dc.contributor.authorMak, Ben_US
dc.date.accessioned2011-09-23T06:23:59Z-
dc.date.available2011-09-23T06:23:59Z-
dc.date.issued2011en_US
dc.identifier.citationJournal of the American Medical Directors Association, 2011, v. 12 n. 2, p. 105-113en_US
dc.identifier.issn1525-8610-
dc.identifier.urihttp://hdl.handle.net/10722/141036-
dc.descriptionComment in J Am Med Dir Assoc. 2011 Feb;12(2):86-87-
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.languageengen_US
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jmda-
dc.relation.ispartofJournal of the American Medical Directors Associationen_US
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 patientsen_US
dc.typeArticleen_US
dc.identifier.emailWoo, J: jeanwoo@hku.hken_US
dc.identifier.emailMak, B: benise@hku.hken_US
dc.identifier.authorityMak, B=rp00602en_US
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.jamda.2010.02.011-
dc.identifier.pmid21266286-
dc.identifier.scopuseid_2-s2.0-78751696081-
dc.identifier.hkuros192272en_US
dc.identifier.volume12en_US
dc.identifier.issue2en_US
dc.identifier.spage105en_US
dc.identifier.epage113en_US
dc.identifier.isiWOS:000287331500007-
dc.publisher.placeUnited States-

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