Measuring Facilitators and Barriers to Quality Measurement and Improvement in Palliative Care Programs: Pilot Results of a Survey for Palliative Care Teams (S719)

Abstract

•Describe key potential facilitators and barriers to quality measurement and improvement in palliative care programs.•Evaluate usability of a survey for palliative care team members to address these barriers and facilitators. Quality measures are not yet widely used in palliative care programs, and methods to better understand their implementation to improve program quality are needed. To pilot test reliability and usability of a survey for team members to evaluate facilitators and barriers to quality measurement and improvement in palliative care programs. We developed a survey using relevant constructs of the Consolidated Framework for Implementation Research, with subscales adapted from validated instruments and refined through cognitive interviews with palliative care quality experts and clinicians. Survey subscales in adaptable modules address issues such as dedicated time, education, communication, teamwork, leadership, and prioritization for quality measurement and improvement for palliative care programs. We evaluated initial reliability (internal consistency within subscales) and usability (range of responses among subscales and qualitative feedback from participants) in a pilot sample of 16 palliative care team members from sites involved in quality measurement and improvement, who completed the survey and participated in discussion groups. We conducted quantitative analyses using STATA 15. Participants included 8 physicians, 3 social workers, and 5 other team members; 44% worked mainly in an inpatient unit, 37% in hospital consultation and 19% in outpatient clinics. Cronbach’s alpha for internal consistency ranged from 0.73-0.99 for all but one subscale. Mean Likert scores (scaled from 1-5) ranged widely among subscales, from a mean of 1.3 to 4.7. In discussion groups, respondents described survey completion as useful for assessing current quality initiatives and addressing strengths and potential improvements, particularly communication, training and engagement of team members about program quality efforts. This novel, adaptable instrument to assess palliative care team perspectives on barriers and facilitators for quality measurement and improvement had acceptable reliability and usability in pilot testing.