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Implementing best practice in palliative care

实施姑息治疗最佳实践

基本信息

批准号：
9357519
负责人：
KIMBERLY S. JOHNSON
金额：
$ 49.73万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-30 至 2018-09-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9357519
关键词：
Implementing best practice palliative care

项目摘要

DESCRIPTION (provided by applicant): Palliative care and hospice focus on the relief of suffering and achieving the best possible quality of life, including ameliorating symptoms, relieving psychological distress, and promoting spiritual well-being for patients their caregivers. The growth of palliative care programs and services in the United States has paralleled the increased realization of the need for a rational, specialized approach to the care for people with advanced life-limiting chronic illness. A relatively new subspecialty, palliative care is building ts evidence base supporting clinical practice. A new National Institute of Nursing Research funded national research network, the Palliative Care Research Cooperative Group (PCRC), is an efficient mechanism for evidence development including comparative effectiveness research. The fundamental next step is efficient implementation of new evidence and emerging clinical care guidelines into practice. Quality monitoring and performance improvement initiatives are an important approach to reinforce evidence implementation. Over the past 5 years, a regional point-of-care quality monitoring program called QDACT-PC has been developed and piloted in North Carolina; it has been demonstrated to be well-liked by clinicians, usable, feasible, and able to generate reliable information that can be used to benchmark conformance with palliative care quality metrics, drive continuous quality improvement (CQI) activities, and reinforce best practice. One example of low conformance with quality metrics identified in QDACT-PC was related to constipation management; data demonstrate that less than 50% of patients are receiving current best practice interventions to manage constipation and that the symptom is persisting at moderate to severe levels until death. We propose to introduce QDACT-PC within engaged research and clinical care footprint of the PCRC to create a national network for point-of-care palliative care quality monitoring, and demonstrate its capabilities for conducting CQI projects and reinforcing contemporary standards for clinical best practice. Specific aims of the project include: (1) To develop and nationally implement a PCRC specific version of QDACT-PC (named QDACT-PCRC). Upgrades planned for QDACT-PCRC include the addition of new data elements and question modules about caregivers, clinical sites characteristics, hospital-based palliative care, and questions relevant to Aims 2 and 3. (2) To demonstrate the use of QDACT-PCRC for CQI by conducting a network-wide CQI project in constipation management. QDACT-PCRC will be used to benchmark current conformance across all sites. PCRC clinical providers will develop a performance improvement program to address the symptom and its management. We will use QDACT-PCRC to monitor impact of the initiative, implementing iterative enhancements to the performance improvement program in order to achieve a goal of >90% conformance. (3) To test the use QDACT-PCRC as a mechanism for delivering clinical decision support that reinforces agreed best clinical practice. Palliative Medicine has recently proposed five clinical activities that should not be conducted as a part of ABIM's Choosing Wisely campaign (e.g. PEG tubes at end of life). We will use QDACT-PCRC to measure current rates of these activities being conducted at PCRC sites, to deliver a point- of-care real time education and clinical decision support module to reinforce best practice and to monitor impact, with iterative cycles of system updates as needed based upon impact. The expected outcome of this project is a national system of real-time point-of-care quality monitoring for palliative care, wit demonstrated capabilities to support CQI and implementation of best evidence. A corollary outcome is an aggregating dataset of quality monitoring and clinical implementation information, forming the PCRC Registry - intended to be a national resource to support quality monitoring, research and learning health care.

描述（由申请人提供）：姑息治疗和临终关怀的重点是减轻痛苦和实现最佳的生活质量，包括改善症状，缓解心理困扰，促进患者及其护理人员的精神健康。美国姑息治疗项目和服务的发展使人们越来越认识到需要一种合理的、专门的方法来治疗晚期限制生命的慢性病患者。姑息治疗是一个相对较新的亚专业，正在建立支持临床实践的证据基础。一个新的国家护理研究所资助的国家研究网络，姑息治疗研究合作组（PCRC），是一个有效的机制，证据发展，包括比较有效性研究。基本的下一步是有效地实施新的证据和新兴的临床护理指南。质量监测和业绩改进举措是加强证据执行工作的一个重要方法。在过去5年中，已在北卡罗来纳州开发并试行了一项名为QDACT-PC的区域性床旁质量监测计划;该计划已被证明深受临床医生的喜爱，可用、可行，并能够生成可靠的信息，可用于衡量姑息治疗质量指标的符合性，推动持续质量改进（CQI）活动，并加强最佳实践。在QDACT-PC中发现的一个质量指标符合性低的例子与便秘管理有关;数据表明，不到50%的患者正在接受当前最佳实践干预来管理便秘，并且症状持续处于中度至重度水平直至死亡。我们建议在PCRC的参与研究和临床护理足迹中引入QDACT-PC，以创建一个用于护理点姑息治疗质量监测的国家网络，并展示其进行CQI项目和加强当代临床最佳实践标准的能力。该项目的具体目标包括：（1）开发并在全国实施QDACT-PC的PCRC特定版本（命名为QDACT-PCRC）。QDACT-PCRC计划的升级包括增加关于护理人员、临床研究中心特征、基于医院的姑息治疗以及与目标2和3相关的问题的新数据元素和问题模块。(2)通过在便秘管理中开展全网CQI项目，演示QDACT-PCRC在CQI中的使用。QDACT-PCRC将用于对所有站点的当前合规性进行基准测试。PCRC临床供应商将制定一个性能改进计划，以解决症状及其管理。我们将使用QDACT-PCRC来监控该计划的影响，对性能改进计划进行迭代增强，以实现>90%的一致性目标。(3)测试QDACT-PCRC作为提供临床决策支持的机制的使用，以加强商定的最佳临床实践。姑息医学最近提出了五个临床活动，不应该作为ABIM的明智选择活动的一部分进行（例如，在生命结束时的PEG管）。我们将使用QDACT-PCRC来衡量在PCRC研究中心进行的这些活动的当前比率，以提供护理点真实的时间教育和临床决策支持模块，从而加强最佳实践并监测影响，并根据影响按需进行系统更新的迭代周期。该项目的预期成果是建立一个全国性的姑息治疗实时护理质量监测系统，该系统具有支持CQI和实施最佳证据的能力。一个必然的结果是质量监测和临床实施信息的聚合数据集，形成PCRC登记-旨在成为支持质量监测，研究和学习医疗保健的国家资源。