Department of Onco-Anesthesia and Palliative Medicine, Dr B. R. Ambedkar, IRCH, AIIMS, New Delhi, India.
VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA.
JCO Glob Oncol. 2022 Oct;8:e2200147. doi: 10.1200/GO.22.00147.
Seven major palliative care (PC) centers in India were mentored through the Palliative Care-Promoting Assessment and Improvement of the Cancer Experience (PC-PAICE) by US and Australian academic institutions to implement a quality improvement (QI) project to improve the accessibility and quality of PC at their respective centers. The objective was to evaluate the experiences of teams in implementing QI methods across diverse geographical settings in India.
A quota sampling approach was used to elicit perspectives of local stakeholders at each site. The Consolidated Framework for Implementation Research informed development of a semistructured interview guide. Analysis leveraged deductive and inductive approaches.
We interviewed 44 participants (eight organizational leaders, 12 clinical leaders, and 24 team members) at seven sites and identified five themes. (1) Implementing QI methods enabled QI teams to think analytically to solve a complex problem and to identify resources. (2) Developing a problem statement by identifying specific gaps in patient care fostered team collaboration toward a common goal. (3) Making use of QI tools (eg, A3 process) systematically provided a new, straightforward QI toolkit and improved QI teams' conceptual understanding. (4) Enhancing stakeholder engagement allowed shared understanding of QI team members' roles and processes and shaped interventions tailored to the local context. (5) Designing less subjective processes for patient care such as assessment scales to identify patient's symptomatic needs positively changed work practices and culture.
Engaging and empowering multiple stakeholders to use QI methods facilitated the expansion and improvement of PC and cancer services in India. PC-PAICE demonstrated an efficient, effective way to apply QI methods in an international context. The impact of PC-PAICE is being magnified by developing a cadre of Indian QI leaders.
通过美国和澳大利亚学术机构的姑息治疗促进评估和改善癌症体验（PC-PAICE），对印度的 7 个主要姑息治疗（PC）中心进行指导，以实施一项质量改进（QI）项目，以提高各自中心 PC 的可及性和质量。目的是评估团队在印度不同地理环境中实施 QI 方法的经验。
采用配额抽样方法，从每个地点征集当地利益攸关者的观点。综合实施研究框架为半结构化访谈指南的制定提供了信息。分析利用了演绎和归纳方法。
我们采访了 7 个地点的 44 名参与者（8 名组织领导、12 名临床领导和 24 名团队成员），确定了 5 个主题。（1）实施 QI 方法使 QI 团队能够进行分析性思考，以解决复杂问题并确定资源。（2）通过确定患者护理中的具体差距来制定问题陈述，促进了团队协作，实现共同目标。（3）系统地使用 QI 工具（例如 A3 流程）提供了新的、直接的 QI 工具包，并提高了 QI 团队的概念理解。（4）增强利益攸关者的参与度，使 QI 团队成员的角色和流程得到共同理解，并根据当地情况调整干预措施。（5）设计评估量表等用于识别患者症状需求的较少主观的患者护理流程，积极改变了工作实践和文化。
让多个利益攸关者参与并赋予他们权力，使用 QI 方法，促进了印度姑息治疗和癌症服务的扩展和改善。PC-PAICE 展示了在国际背景下应用 QI 方法的有效途径。通过培养一批印度 QI 领导者，PC-PAICE 的影响力正在扩大。
