Improving palliative care in selected settings in England using quality indicators: a realist evaluation

Area of Science:

• Palliative Care
• Healthcare Quality Improvement
• Health Services Research

Background:

• A significant gap exists between evidence-based palliative care practices and their implementation in routine care.
• The IMPACT study aimed to assess the effectiveness of facilitated Quality Indicator (QI) use to enhance palliative care.

Purpose of the Study:

• To evaluate the potential of using a facilitated Quality Indicator (QI) set to improve palliative care delivery.
• To assess the feasibility and impact of QI implementation across diverse healthcare settings.

Main Methods:

• Development of a QI set for palliative care interventions.
• Case studies involving QI implementation in general practice, community palliative care teams, care homes, hospital wards, and hospices.
• Before-and-after evaluations and realist evaluation of implementation processes and outcomes.

Main Results:

• Hospital wards, hospices, and community palliative care teams successfully utilized QIs to achieve desired improvements, including enhanced electronic records and standardized information transfer.
• General practices and care homes faced challenges with recruitment and retention, indicating lower engagement with the QI intervention.
• Realist evaluation highlighted that organizational commitment to continuous improvement and perceived value of QIs influenced uptake, with top-down approaches sometimes hindering implementation.

Conclusions:

• Facilitated use of Quality Indicators (QIs) can drive improvements in specialist palliative care settings.
• The study suggests that distinct QI sets may be necessary for generalist care settings to ensure successful adoption and impact.