If You Want to Go Far, Go Together: Lessons Learned from Quality Improvement Collaboratives in Palliative Care

An ongoing commitment to quality improvement (QI) is essential in palliative care (PC), where patients are often frail, suffering is pervasive, and time may be short. Multicenter collaboration in QI allows PC teams to share and harness innovations and approaches from colleagues across the country and around the world. In order to learn at scale, PC teams must be able to directly compare their practices through standardized measurement and reporting of program structures, processes of care, and patient- and institution-level outcomes. Several PC projects around the world adopted this approach to standardized data collection and benchmarking to monitor quality, identify gaps in care, and promote best practices. We highlight lessons learned from these QI collaboratives. Key insights include that PC teams can collect standardized patient-level outcome data in the course of clinical care that can illuminate variations, gaps in care, and best practices. Further, data showed that there is a wide variation in PC practice and outcomes that cannot be explained by the resources available, even for core care parameters. We also found that PC practice is evolving such that PC teams are caring for more patients with conditions other than cancer and more patients are being referred to outpatient PC. Additionally, significant improvements in outcomes, including pain, are possible and PC teams can also use QI data to support requests for additional resources and for research to advance our field. The work of these organizations highlights our obligation to the people we serve to show that we are learning organizations, committed absolutely to improving quality of care, quality of life, and the meaningful outcomes that matter to our patients and their families. Future collaborative QI initiatives in PC are needed to ensure and improve quality of care.