Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA.
Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA.
J Gen Intern Med. 2021 Feb;36(2):366-373. doi: 10.1007/s11606-020-06152-y. Epub 2020 Sep 8.
Quality improvement (QI) methods represent a vehicle for fostering locally initiated innovation cycles. We partnered with palliative care services from seven diverse practice settings in India to foster locally initiated improvement projects.
To evaluate the implementation experiences of locally initiated palliative care improvement projects at seven diverse sites and understand the barriers and facilitators of using QI to improve palliative care in India.
We use a quota sampling approach to capture the perspectives of 44 local stakeholders in each of the following three categories (organizational leaders, clinic leaders, and clinical team members) through a semi-structured interview guide informed by the consolidated framework for implementation research (CFIR). We use standard qualitative methods to identify facilitators and barriers to using QI methods in seven diverse palliative care contexts.
Across all sites, respondents emphasized the following factors important in the success of quality improvement initiative: leveraging clinic level data, QI methods training, provider buy-in, engaged mentors, committed leadership, team support, interdepartmental coordination, collaborations with other providers, local champions, and having a structure for accountability. Barriers to using QI methods to improve palliative care services included lack of designated staff, high patient volume, resources, patient population geographic constraints, general awareness and acceptance of palliative care, and culture.
Empowering local leaders and medical personnel to champion, design, and iterate using QI methods represents a promising powerful tool to spread palliative care services in developing countries.
质量改进 (QI) 方法代表了促进本地创新周期的一种手段。我们与来自印度七个不同实践环境的姑息治疗服务机构合作，以促进本地发起的改进项目。
评估在七个不同地点开展的本地发起的姑息治疗改进项目的实施经验，并了解在印度使用 QI 改善姑息治疗的障碍和促进因素。
我们使用配额抽样方法，通过基于综合实施研究框架 (CFIR) 的半结构化访谈指南，从以下三个类别中的每一类（组织领导者、诊所领导者和临床团队成员）中捕获 44 名本地利益相关者的观点。我们使用标准的定性方法来确定在七个不同的姑息治疗环境中使用 QI 方法的障碍和促进因素。
在所有地点，受访者都强调了以下因素对质量改进计划的成功至关重要：利用诊所层面的数据、QI 方法培训、提供者的认可、积极的指导者、坚定的领导、团队支持、部门间协调、与其他提供者的合作、当地拥护者以及建立问责制结构。使用 QI 方法来改善姑息治疗服务的障碍包括缺乏指定的员工、高患者量、资源、患者群体的地理限制、普遍的姑息治疗意识和接受度以及文化。
赋予当地领导人和医务人员权力，使其成为QI 方法的拥护者、设计者和迭代者，是在发展中国家推广姑息治疗服务的一种很有前途的有力工具。
