Implementation of an Early Palliative Care Referral Program in Lung Cancer: A Quality Improvement Project at the Tata Memorial Hospital, Mumbai, India.
Implementation of an Early Palliative Care Referral Program in Lung Cancer: A Quality Improvement Project at the Tata Memorial Hospital, Mumbai, India.
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DOI：
10.25259/ijpc_394_20
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发表时间：
2021-04
影响因子：
1.1
通讯作者：
Pramesh CS
中科院分区：
文献类型：
--
作者：
Ghoshal A;Deodhar J;Adhikarla C;Tiwari A;Dy S;Pramesh CS
尽管有建议，但所有转移性肺癌患者的早期姑息治疗（EPC）尚未实现。该质量改进（QI）项目的初始化是为了提高印度一家顶级癌症中心所有新门诊患者从胸部肿瘤诊所转诊的比率。探索了干预期间和干预后（2018年4月至5月）接受EPC转诊的患者比例与基线（2018年1月至3月）相比的变化。干预措施包括了解工艺流程，确定关键驱动因素，并进行根本原因分析，将差距确定为缺乏EPC文件。教导和鼓励诊所的工作人员将转诊纳入转移性肺癌患者的所有初次就诊。QI干预的捆绑将转诊从平均50%增加到75%，平均差异= 12.64（标准差= 10.13）（95%置信区间= 22.01-3.29），配对样本检验P = 0.016（双尾）。通过QI项目，多学科癌症诊所的EPC转诊率可能会有所提高。该项目还确定了数据记录和患者信息流程的重要性，可以有针对性地进行改进。
Access to early palliative care (EPC) for all patients with metastatic lung cancer is yet to be achieved in spite of recommendations. This quality improvement (QI) project was initialized to improve the rates of such referrals from the thoracic oncology clinic for all new outpatients in a premier cancer center in India. Change in the proportion of patients receiving referrals for EPC during and after intervention (April–May 2018), compared to baseline (January–March 2018) were explored. Interventions included understanding of the process flow, identification of key drivers, and root cause analysis which identified the gaps as lack of documentation for EPC. Teaching and encouraging staff at the clinic to incorporate referrals into all initial visits for patients with metastatic lung cancer were incorporated. The bundle of QI interventions increased referrals from an average of 50% to 75%, mean difference = 12.64 (standard deviation = 10.13) (95% confidence interval = 22.01–3.29), P = 0.016 (two-tailed) on paired sample test. Improved referral rates for EPC in a multidisciplinary cancer clinic is possible with a QI project. This project also identifies the importance of data documentation and patient information processes that can be targeted for improvement.