Quality Improvement Effort With Proactive Social Worker Communication to Enhance Palliative Care Access

Area of Science:

• Oncology
• Health Services Research
• Quality Improvement

Background:

• Access to specialty palliative care (PC) is crucial for patients with advanced cancer.
• Quality improvement projects aim to bridge the gap between evidence-based PC and real-world application.
• Social worker-led interventions are being explored to enhance PC access.

Purpose of the Study:

• To evaluate a quality improvement initiative designed to increase access to specialty palliative care (PC) for advanced cancer patients.
• To assess the impact of a social worker-led program on PC referrals and utilization.

Main Methods:

• A difference-in-difference analysis compared a social worker-led PC intervention site with three control sites using usual care.
• Intention-to-treat analysis examined changes in PC referrals (primary outcome) and end-of-life outcomes.
• Multivariable logistic and Poisson regressions were used to compare outcomes pre- and post-implementation.

Main Results:

• The intervention site saw a modest increase in PC referrals (30.4% to 32.7%) compared to control sites (26.7% to 25.3%).
• PC visits increased at the intervention site, with a notable rise in visits among decedents (53.1% to 75%).
• Adjusted analyses showed a near-significant trend towards increased PC visits before death at the intervention site (OR, 3.09; P = .07).

Conclusions:

• The social worker-led intervention was not associated with a statistically significant increase in palliative care referrals.
• Translating evidence-based PC interventions into real-world quality improvement requires careful consideration of context and potential modifications.
• Further research is needed to optimize the effectiveness of social worker-led PC initiatives in diverse healthcare settings.