Policy Research & Analysis, Cancer Care Ontario, Toronto, Ontario, Canada.
J Pain Symptom Manage. 2012 Apr;43(4):663-78. doi: 10.1016/j.jpainsymman.2011.04.028.
The Provincial Palliative Care Integration Project (PPCIP) was implemented in Ontario, Canada, to enhance the quality of palliative care delivery. The PPCIP promoted collaboration and integration across service sectors to improve screening and assessment, palliative care processes, as well as clinician practice and outcomes for cancer patients.
The project involved 1) implementation of the Edmonton Symptom Assessment System (ESAS) for symptom screening, 2) use of "rapid-cycle change" quality improvement processes to improve screening and symptom management, and 3) improvements in integration and access to palliative care services.
Symptom scores were collected and made accessible to the care team through a web-based tool and kiosk technology, which helped patients enter their ESAS scores at each visit to the regional cancer center or at home with their nurse. Symptom response data were gathered through clinical chart audits.
Within one year of implementation, regional cancer centers saw improvements in symptom screening (54% of lung cancer patients), symptom control (69% of patients with pain scores and 31% of patients with dyspnea scores seven or more were reduced to six or less within 72 hours), and functional assessment (23% of all patients and 64% of palliative care clinic patients). ESAS screening rates reached 29%, and functional assessment reached 26% of targeted home care patients.
The PPCIP demonstrated that significant strides in symptom screening and response can be achieved within a year using rapid-cycle change and collaborative approaches. It showed that both short- and long-term improvement require ongoing facilitation to embed the changes in system design and change the culture of clinical practice.
安大略省实施了省级姑息治疗整合项目（PPCIP），以提高姑息治疗的质量。该项目促进了服务部门之间的合作和整合，以改善癌症患者的筛查和评估、姑息治疗流程以及临床医生的实践和结果。
该项目涉及 1）实施埃德蒙顿症状评估系统（ESAS）进行症状筛查，2）使用“快速循环变革”质量改进流程来改善筛查和症状管理，以及 3）改善姑息治疗服务的整合和可及性。
通过基于网络的工具和信息亭技术收集症状评分，并使护理团队能够访问这些评分，该技术帮助患者在每次前往区域癌症中心就诊或在家中与护士就诊时输入他们的 ESAS 评分。通过临床图表审核收集症状反应数据。
在实施后的一年内，区域癌症中心在症状筛查（54%的肺癌患者）、症状控制（疼痛评分达到 7 分或以上的患者中有 69%，呼吸困难评分达到 7 分或以上的患者中有 31%在 72 小时内降至 6 分或以下）和功能评估（所有患者中有 23%，姑息治疗诊所患者中有 64%）方面取得了改善。ESAS 筛查率达到 29%，针对目标家庭护理患者的功能评估达到 26%。
PPCIP 表明，在一年内使用快速循环变革和协作方法可以在症状筛查和反应方面取得显著进展。它表明，短期和长期改善都需要持续的促进，以将变革嵌入系统设计中，并改变临床实践的文化。
