| Title |
Improving palliative care in selected settings in England using quality indicators: a realist evaluation
|
|---|---|
| Published in |
BMC Palliative Care, August 2016
|
| DOI | 10.1186/s12904-016-0144-1 |
| Pubmed ID | |
| Authors |
Steve Iliffe, Nathan Davies, Jill Manthorpe, Peter Crome, Sam H Ahmedzai, Myrra Vernooij-Dassen, Yvonne Engels |
| Abstract |
There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England. 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service change in selected settings (general practice, community palliative care teams, care homes, hospital wards, in-patient hospices) with a before-and-after evaluation, and 3) realist evaluation of processes and outcomes across settings. Participants in each setting were supported to identify no more than three Quality Indicators to work on over an eight-month period in 2013/2014. General practices could not be recruited to the study. Care homes were recruited but not retained. Hospital wards were recruited and retained, and using the Quality Indicator (QI) set achieved some of their desired changes. Hospices and community palliative care teams were able to use the QI set to achieve almost all their desired changes, and develop plans for quality improvements. Improvements included: increasing the utility of electronic medical records, writing a manual for end of life care, establishing working relationships with a hospice; standardising information transfer between settings, holding regular multi-disciplinary team meetings, exploration of family carers' views and experiences; developing referral criteria, and improvement of information transfer at patient discharge to home or to hospital. Realist evaluation suggested that: 1) uptake and use of QIs are determined by organisational orientation towards continuous improvement; 2) the perceived value of a QI package was not powerful enough for GPs and care homes to commit to or sustain involvement; 3) the QI set may have been to narrow in focus, or more specialist than generalist; and 4) the greater the settings' 'top-down' engagement with this change project, the more problematic was its implementation. Whilst use of QIs may facilitate improvements in specialist palliative care services, different QI sets may be needed for generalist care settings. |
X Demographics
The data shown below were collected from the profiles of 7 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 3 | 43% |
| Canada | 1 | 14% |
| Unknown | 3 | 43% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 6 | 86% |
| Practitioners (doctors, other healthcare professionals) | 1 | 14% |
Mendeley readers
The data shown below were compiled from readership statistics for 202 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 1 | <1% |
| United States | 1 | <1% |
| Denmark | 1 | <1% |
| Unknown | 199 | 99% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 28 | 14% |
| Researcher | 24 | 12% |
| Student > Ph. D. Student | 19 | 9% |
| Student > Bachelor | 16 | 8% |
| Other | 12 | 6% |
| Other | 37 | 18% |
| Unknown | 66 | 33% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 37 | 18% |
| Nursing and Health Professions | 35 | 17% |
| Social Sciences | 24 | 12% |
| Psychology | 9 | 4% |
| Biochemistry, Genetics and Molecular Biology | 3 | 1% |
| Other | 18 | 9% |
| Unknown | 76 | 38% |
Attention Score in Context
This research output has an Altmetric Attention Score of 4. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 18 May 2017.
All research outputs
#7,115,080
of 23,881,329 outputs
Outputs from BMC Palliative Care
#783
of 1,308 outputs
Outputs of similar age
#118,049
of 371,483 outputs
Outputs of similar age from BMC Palliative Care
#17
of 27 outputs
Altmetric has tracked 23,881,329 research outputs across all sources so far. This one has received more attention than most of these and is in the 69th percentile.
So far Altmetric has tracked 1,308 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 9.6. This one is in the 39th percentile – i.e., 39% of its peers scored the same or lower than it.
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We're also able to compare this research output to 27 others from the same source and published within six weeks on either side of this one. This one is in the 40th percentile – i.e., 40% of its contemporaries scored the same or lower than it.