Quality improvement for symptom control in underserved Chinese cancer patients.

Abstract

132 Background: Chinese Americans, the largest Asian subgroup, have high cancer rates. Many are recent immigrants who are economically disadvantaged. Patients often present with advanced illness and poorly controlled pain. Although quality improvement (QI) methodologies, such as rapid-cycle QI, may improve clinical practice and patient outcomes, few QI programs for pain management exist for this population. We aim to 1) test the effectiveness of a rapid-cycle QI intervention to enhance the processes and outcomes of pain management for poor and underserved ethnic Chinese patients; 2) determine whether a rapid-cycle QI intervention for pain can be generalized to other symptoms (fatigue and dyspnea), and 3) identify demographic, cultural, and other barriers and facilitators that are related to intervention uptake. Methods: In this ongoing community study, we are developing and testing a rapid-cycle QI model to improve pain among underserved Chinese American cancer patients, and evaluating factors that influence its uptake and sustainability. Ethnic Chinese patients and clinicians from four oncology practices are the intervention targets. The systems-based intervention incorporates repeated “plan-do-study-assess” QI cycles, including: pain screening, follow-up and early treatment for pain, referral, and provider education. Results: Initial data demonstrates that documentation of pain scores improved from 24-71% of patients overall. In one practice, 37% of 89 patients screened over 45 days had moderate or severe pain; 90% with moderate pain had follow-up appointments within 1 week; 92% with severe pain had immediate clinician attention. Intervention effectiveness will be determined by 2-week longitudinal surveys. The primary outcome is the change in the proportion of patients who achieve adequate and timely pain control after initial presentation. Conclusions: Multiple cultural, system-related, and provider challenges to QI implementation are being addressed. Findings will show the importance of QI interventions to reduce pain disparities, the importance of programs that address underserved Chinese Americans, and the relevance of community-based QI programs for long-term changes in clinical pain management.