A Survey to Evaluate Facilitators and Barriers to Quality Measurement and Improvement: Adapting Tools for Implementation Research in Palliative Care Programs

Sydney M Dy; Nebras Abu Al Hamayel; Susan M Hannum; Ritu Sharma; Sarina R Isenberg; Kamini Kuchinad; Junya Zhu; Katherine Smith; Karl A Lorenz; Arif H Kamal; Anne M Walling; Sallie J Weaver

doi:10.1016/j.jpainsymman.2017.06.008

A Survey to Evaluate Facilitators and Barriers to Quality Measurement and Improvement: Adapting Tools for Implementation Research in Palliative Care Programs

J Pain Symptom Manage. 2017 Dec;54(6):806-814. doi: 10.1016/j.jpainsymman.2017.06.008. Epub 2017 Aug 9.

Authors

Affiliations

¹ Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA; Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. Electronic address: dy1@jhu.edu.
² Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
³ Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁴ Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
⁵ Stanford School of Medicine, Stanford, California, USA.
⁶ Duke Cancer Institute, Duke University, Durham, North Carolina, USA.
⁷ VA Greater Los Angeles Health System, University of California, Los Angeles, Los Angeles, California, USA.
⁸ National Cancer Institute, Bethesda, Maryland, USA.

Abstract

Context: Although critical for improving patient outcomes, palliative care quality indicators are not yet widely used. Better understanding of facilitators and barriers to palliative care quality measurement and improvement might improve their use and program quality.

Objectives: Development of a survey tool to assess palliative care team perspectives on facilitators and barriers to quality measurement and improvement in palliative care programs.

Methods: We used the adapted Consolidated Framework for Implementation Research to define domains and constructs to select instruments. We assembled a draft survey and assessed content validity through pilot testing and cognitive interviews with experts and frontline practitioners for key items. We analyzed responses using a constant comparative process to assess survey item issues and potential solutions. We developed a final survey using these results.

Results: The survey includes five published instruments and two additional item sets. Domains include organizational characteristics, individual and team characteristics, intervention characteristics, and process of implementation. Survey modules include Quality Improvement in Palliative Care, Implementing Quality Improvement in the Palliative Care Program, Teamwork and Communication, Measuring the Quality of Palliative Care, and Palliative Care Quality in Your Program. Key refinements from cognitive interviews included item wording on palliative care team members, programs, and quality issues.

Conclusion: This novel, adaptable instrument assesses palliative care team perspectives on barriers and facilitators for quality measurement and improvement in palliative care programs. Next steps include evaluation of the survey's construct validity and how survey results correlate with findings from program quality initiatives.

Keywords: Implementation research; cognitive interviews; palliative care; quality improvement; quality measurement; survey.

Publication types

Evaluation Study

MeSH terms

Attitude of Health Personnel
Health Personnel / psychology
Humans
Interviews as Topic
Palliative Care* / methods
Quality Improvement*
Quality Indicators, Health Care*
Surveys and Questionnaires*

Grants and funding

R21 CA197362/CA/NCI NIH HHS/United States