Quality Of Care Delivery Research Articles

The use of mobile electronic prescribing to drive quality of oncology care delivery.

586 Background: This pilot technology enhancement project set out to improve the quality of care for oncology patients by developing a mobile application for writing prescriptions (non-chemotherapy) and narcotics. We describe usage of this new mobile application and associated timeliness of care delivery, provider workflow efficiencies and patient safety metrics. Methods: Agile methodology was used to develop the workflow and software for the mobile application. Internal Patient Safety Usability Testing (PSUT) was used to assess high-risk tasks amongst potential users (n = 7). High-risk tasks were defined as those which, based on human error, could lead to potential patient harm or unsafe conditions. High-risk tasks included the ability for users to understand/acknowledge allergy and drug interactions, edit a selection, select and send to the appropriate pharmacy, and locate the record of the completed prescription within the patient’s chart through the mobile application. A pilot study was also conducted among oncologists (n = 14). A quantitative metric was measured to understand the adoption and usability of the mobile application. Qualitative feedback was also obtained. Results: 1. PSUT identified a need for improvement with recognition of interaction severity and differentiating an allergy versus a drug interaction. A design modification was also made to introduce a three-second hold to acknowledge an allergy. This was done to encourage users to take appropriate time to visualize and comprehend allergy and interaction information before advancing the workflow. 2. During the pilot study, 400 mobile prescriptions were written. After-hours writing of prescriptions in the mobile application increased (11.8%) compared to the EMR (3.5%). The average amount of time from initiation of writing a prescription to completion was 62 seconds in the mobile application. There were no high-risk patient safety incidents observed during the pilot study. Qualitative data from participants included themes around convenience, feasibility, improved access to care, and safety. Conclusions: Usage of the pilot mobile application demonstrated a safe and efficient approach to increase the quality of care delivery for oncology patients. Usage also suggests an increase in patient access to care after hours.

An evidence-based quality assessment tool for ovarian cancer care delivery.

384 Background: Ovarian cancer is the fifth leading cause of cancer death among women in the United States (US). Optimizing care for patients with ovarian cancer using a systematic, guideline-concordant approach improves outcomes. However, notable gaps persist for most patients with ovarian cancer in the US. Beginning in 2018, the Association of Community Cancer Centers (ACCC) implemented a quality improvement (QI) initiative in community and academic cancer centers to address care gaps. From this work, our expert steering committee published a quality document to inform evidence based ovarian cancer care delivery. Methods: In Phase II of this project we used the quality document to inform a qualitative baseline self-assessment and development of four six-month QI initiatives at cancer centers in the US. Based on this work, we developed a quality assessment tool to aid cancer centers in performing QI needs-assessments using the ovarian cancer quality document. The assessment tool applies evidence-based care recommendations in key areas identified by our multidisciplinary steering committee comprised of experts in ovarian cancer care. Results: The assessment tool includes a series of program-level questions and addresses seven key domains: 1. Care coordination and patient education, 2. Prevention and screening, 3. Diagnosis and initial management, 4. Treatment planning, 5. Disease surveillance, 6. Equity in care, and 7. Quality of life. Each domain has between two and seven key recommendations identified. Sites rate themselves on a four-point scale (1-unsatisfactory, 2-needs improvement, 3-acceptable, 4-good) for each key recommendation. Each key recommendation is given equal weight, and a combined score from 0-100 is calculated for each of the seven domains. The tool includes a macro-enabled spreadsheet that makes necessary calculations and provides an overall score, domain-specific sub-scores, and a list of key recommendations that received low ratings. The tool is to be used by clinical sites to self-assess the quality of ovarian cancer care currently provided at their cancer program and serves as a needs assessment. It is recommended that the site team performs the self-assessment in the context of a facilitated half-day multidisciplinary team meeting. After the self-assessment, sites are encouraged to develop QI initiatives to address the gaps identified using the format and structure we have previously described. Conclusions: The QI Assessment tool provides an important resource for cancer centers to conduct needs assessments in key areas of ovarian cancer care. The needs assessment can be used to inform the implementation of program-specific QI initiatives to elevate quality care delivery.

Exodus of Lebanese doctors in times of crisis: a qualitative study.

Since 2019, Lebanon is experiencing an unprecedented exodus of doctors, seriously threatening the national health system, which is expected to continue without quick and effective solutions. Therefore, this study aimed to understand the factors that push Lebanese doctors to migrate and the factors that retain others in the country. Additionally, this study aims to propose solutions to preserve an adequate supply of medical care amidst the crisis. Qualitative semi-structured interviews and focus group discussions were conducted using pre-developed guides. Purposive and snowball sampling was adopted to recruit physicians who emigrated and physicians staying in Lebanon. Transcripts of interviews and focus groups were coded using Dedoose software and analyzed through a combination of inductive and deductive approaches. Emigration was found to be the result of numerous interconnected factors. The main drivers for emigration were declining income, career problems, reduced quality of care, unhealthy work environment, and the deteriorated political and socio-economic contexts leading to instability and insecurity. As for the retention factors, they included affective attachment and sense of belonging to the professional environment and the country, followed by recognition and valorization at work. Several recommendations were developed to maintain quality of care delivery, including reforms of the health system, development of focused human resource retention strategies based on resource mapping evidence, negotiations with recruiting institutions to endorse the code ethics ending unethical practices draining countries' human resources, provision of financial incentives to doctors, and the recognition and valorization of physicians. Other rapid interventions were suggested, such as short-term medical missions to mitigate shortages in certain specialties, telemedicine, adaptation of recruitment processes to compensate for resources shortages in certain specialties, and adoption of task-shifting approaches to alleviate the workload on overburdened specialists. The findings of this study shed the light on the different factors influencing migration while framing them in the Lebanese context. These findings and recommendations should inform stakeholders and policy makers about the interventions needed to restore the quality of care. The feasibility and sustainability of most formulated recommendations depend on several factors, with political and socio-economic security and stability being the most crucial ones.

A mixed methods evaluation of a digital antenatal quality improvement intervention in Nepal

Abstract Background Quality antenatal care plays an important role in reducing maternal and perinatal mortality. Electronic decision support systems (EDSS) aim to promote adherence to evidence-based practices. The evaluation aimed to assess the effectiveness of the intervention on improving quality of antenatal care (ANC) and understanding of implementation process and intervention effects. Methods The study was conducted in primary health care settings in Nepal. Theory of change framework was used for mixed-method evaluation. Quantitative and qualitative data were collected at multiple time points. Data were integrated using concurrent triangulation to develop explanations about the implementation process and the observed effects. Results Guided by our theory of change, we identified eleven themes that help to understand how the EDSS was used in the real context, and why the EDSS was not much effective in bringing the desired changes that was required to improve quality of ANC. EDSS appear to slightly influence ANC staff behavior, however, training ANC staff in using the EDSS did not necessarily lead to confidence in using it and ANC staff used the EDSS as recordkeeping system. We found mixed evidence on ANC staff believe that the EDSS offers benefits to their work. Inflexibility of EDSS during ANC consultation caused difficulties adapting to women's need and challenging to integrate the EDSS in ANC staffs’ workflow and daily activities. Inadequate linkage of the EDSS with existing health systems impaired the EDSS guided clinical performance. Conclusions There is some indication that the EDSS have the potential to increase the quality of care. However, the EDDS alone are not enough to bring the adequate change in ANC staff delivery of quality care. Active participation of government and grassroot level understanding of health system would be essential considering conducting further research taking in account the resources, and other factors that hinders the EDSS utilization. Key messages • Concurrent triangulation helps to understand that digital health intervention is not enough to bring intended changes in the quality-of-service delivery at health facility. • Understanding of context and ground reality is essential to improve the quality of care and enhance the performance of healthcare providers.

Theoretical Models of Collaborative Partnerships in Arts-Health Care Practices for Older Adults.

Although research investigating collaborative partnerships with older adults has been slow to develop, promoting user involvement and co-production is gaining interest in aging studies, with the aim of improving interactions between the different stakeholders involved, and toward the more effective delivery of care provisions and better community life for aging people. This is based on existing evidence that improved dynamics within collaborative and mutual learning processes can enhance the integration of new practices at different levels by generating novel creative approaches and practice frameworks for the delivery of quality care for older adults. This article presents the findings from a series of narrative interviews conducted with different stakeholders involved in arts-health practices in Finland and South Korea. Focusing on empirical perspectives of these stakeholders on arts-health practices-from planning to assessment-this study identifies vital components of co-producing and co-delivering arts-health practices for older adults and highlights the importance of utilizing their late-life creativity as active partners in such practices across cultural contexts. In addition to identifying three central stages of developing arts-health practices, two theocratical models are proposed to provide structural support for collaborative partnerships in arts-health practices, with the aim of promoting holistic care provisions for aging people through such practices.

Mental health deserves better: Resisting the dilution of specialist pre-registration mental health nurse education in the United Kingdom.

This article aims to draw attention to increasing genericism in nurse education in the United Kingdom, which sees less specialist mental health education for mental health nursing students and offers opposition to such direction. In 2018, the Nursing and Midwifery Council produced the 'Future Nurse' standards which directed changes to pre-registration nurse education. This led to dissatisfaction from many mental health nurses, specifically regarding reduced mental health content for students studying mental health nursing. Concerns have been raised through public forum and evolved into a grassroots national movement 'Mental Health Deserves Better' (#MHDeservesBetter). This is a position paper which presents the perspective of many mental health nurse academics working at universities within the United Kingdom. Mental health nurse academics collaborated to develop ideas and articulate arguments and perspectives which present a strong position on the requirement for specialist pre-registration mental health nurse education. The key themes explored are; a conflict of ideologies in nursing, no parity of esteem, physical health care needs to be contextualized, the unique nature of mental health nursing, ethical tensions and values conflict, implications for practice, necessary improvements overlooked and the dangers of honesty and academic 'freedom'. The paper concludes by asserting a strong position on the need for a change of direction away from genericism and calls on mental health nurses to rise from the ashes to advocate for a quality education necessary to ensure quality care delivery. The quality of mental health care provided by mental health nurses has many influences, yet the foundation offered through pre-registration education is one of the most valuable. If the education of mental health nurses does not attend to the distinct and unique role of the mental health nurse, standards of mental health care may diminish without assertive action from mental health nurses and allies.

How to be an authentic leader, 1. Understanding authentic leadership

Strong leaders with an approach that supports, empowers and inspires staff are vital to the delivery of quality care and services for patients and service users. Every failing identified in the NHS, and the subsequent reviews examining them have pointed to the failing of leadership to maintain the standards of care, protection and quality required for clinical services eg Mid Staffordshire ( Francis, 2013 ) and the Shipman Inquiries ( Smith, 2003 ). Over the next few months, we will be looking at several leadership styles and how these can impact on patients, staff and health and social care. In simple terms, a leader influences others (either directly, or by delegating) to carry out a specific action or set of objectives. The essence of followers and followership is considered by authors as an essential aspect of understanding leadership and the importance of the interaction between the two parties ( Winston and Patterson, 2006 ). Authentic leadership is one of the leadership styles that is categorised as relational eg it focuses on building relationships with others, and it is also seen as a positive leadership form (Malila et al, 2017). Authentic leaders are considered to be key in creating improved nursing and organisational outcomes through promoting a positive emotional wellbeing and such leadership is associated with lower staff turnover ( Laschinger et al, 2016 ; Lee et al, 2019 ). Furthermore, authentic leadership has been linked with improved patient outcomes ( Boamah et al, 2017 ).

Implementing 3rd-year learning disability student nurse-led clinics and evaluating self-efficacy and confidence

Background Workplace self-confidence and self-efficacy has been strongly associated with increased coping strategies, job satisfaction and resilience to workplace adversity ( Bandura, 1982 ) which results in higher quality care delivery. The main aim was to evaluate the growth of confidence and autonomy in developing a Learning Disability professional identity within primary care settings, through student led clinics, utilising a long arm supervision approach. Methodology/Methods An explorative hermeneutic phenomenology approach, using semi structured interviews was utilised to explore themes and experiences around self-efficacy and confidence in students, practice assessors and supervisors. Findings Long arm approach is an effective learning approach for students to develop their own autonomy in primary care clinics. However, placement planning and a supportive environment are vital for its success and for the student to build self-efficacy and autonomy in a primary care setting. Conclusion and Implications Increased confidence is viewed as a crucial factor in evolving role identity and managing change which are major factors in the preparation for registration and joining the healthcare workforce. The 3rd year Learning Disability nurse led clinics did have impact on workforce well-being by alleviating workload on quality outcomes and frameworks (QOF); prepared students for autonomous working; and increase practitioners’ confidence in using long arm supervision.

In our responses to the overdose epidemic, we cannot forget pregnant and postpartum people.

In 2021, there were over 100,000 drug overdose deaths in the United States (US). Death rates have increased faster among women than men, particularly among Black and Indigenous people. Although drug overdose is a leading cause of pregnancy-associated deaths, birthing people are rarely emphasized in discussions of overdose and research and services remain limited. Data show increases in drug use and deaths among women of child-bearing age, with risks continuing in the postpartum period. Harms experienced by birthing people who use drugs occur in the context of broader inequities in maternal morbidity and mortality that lead to disparate reproductive health outcomes. Shared structural antecedents (e.g. intersecting sexism and racism, stigma, and punitive policies) underlie overlapping epidemics of overdose and maternal morbidity and mortality. Here we discuss the unique challenges placed on birthing people who use drugs and make recommendations on how to mitigate harms by improving access to and delivery of quality care and addressing unjust policies and practices. We highlight the need for integrated health services, clearer guidelines rooted in equity, and the need for changes to policy and practice that support rather than punish. To better serve individuals and families impacted by substance use, we need multilevel solutions that advance gender equity and racial justice to reshape and/or dismantle the systems that undergird oppression.

The Impact of Hygiene Status on Caregiving for Older Adults among Certified Nursing Assistants in China Nursing Facilities: Occupational Ethics and Working Attitudes as Mediators in Parallel

Certified nursing assistants’ quality of caregiving for older adults exerts a positive impact on their occupational careers. Hygiene status of certified nursing assistants in nursing facilities may protect QOCD from positive working achievement. The impact of hygiene status of certified nursing assistants on QOCD for older adults were proved in the observational cross-sectional study. Care giving appraisal were used to survey 104 certified nursing assistants. Arbitrating effects were in-depth analyzed by SPSS 25.0 and Process V3.5. Hygiene status definitely unraveled quality of care delivery. Meanwhile, it was also found that hygiene status, and quality of care delivery were arbitrated in parallel by occupational ethics and working attitudes. Value of 0.469 was total indirect, explaining 49.5%. The innovative study introduces how hygiene status influences caregivers’ quality of care delivery in pension apartment. Hygiene status could provide certified nursing assistants with a favorable supervising and assessing positive occupational quality, enhance the occupational ethics and working attitudes, ultimately improve their quality of care delivery.

Development of practice-based quality indicators for the primary care of older adults: a RAND/UCLA Appropriateness Method study protocol

IntroductionOlder adults have high rates of primary care utilisation, and quality primary care has the potential to address their complex medical needs. Family physicians have different levels of knowledge and...

The hospital-to-home care transition experience of home care clients: an exploratory study using patient journey mapping

BackgroundCare transitions have a significant impact on patient health outcomes and care experience. However, there is limited research on how clients receiving care in the home care sector experience the hospital-to-home transition. An essential strategy for improving client care and experience is through client engagement efforts. The study's aim was to provide insight into the care transition experiences and perspectives of home care clients and caregivers of those receiving home care who experienced a hospital admission and returned to home care services by thematically and illustratively mapping their collective journey.MethodsThis study applied a qualitative descriptive exploratory design using a patient journey mapping approach. Home care clients and their caregivers with a recent experience of a hospital discharge back to the community were recruited. A conventional inductive approach to analysis enabled the identification of categories and a collective patient journey map. Follow-up interviews supported the validation of the map.ResultsSeven participants (five clients and two caregivers) participated in 11 interviews. Participants contributed to the production of a collective journey map and the following four categories and themes: (1) Touchpoints as interactions with the health system; Life is changing; (2) Pain points as barriers in the health system: Sensing nobody is listening and Trying to find a good fit; (3) Facilitators to positive care transitions: Developing relationships and gaining some continuity and Trying to advocate, and (4) Emotional impact: Having only so much emotional capacity.ConclusionsThe patient journey map enabled a collective illustration of the care transition depicted in touchpoints, pain points, enablers, and feelings experienced by home care recipients and their caregivers. Patient journey mapping offers an opportunity to acknowledge home care clients and their caregivers as critical to quality care delivery across the continuum.

Evaluating the Impact of DevOps Practice in the U.S. Health Care Systems

The adoption of DevOps practices in the U.S. healthcare system has garnered significant attention in recent years, promising improved efficiency, collaboration, and quality of care delivery. This paper critically evaluates the impact of DevOps practices within the intricate landscape of healthcare systems in the United States. Through a systematic analysis of case studies, empirical research, and industry reports, this study assesses the extent to which DevOps principles have been implemented and their effects on various aspects of healthcare operations. Key metrics such as deployment frequency, lead time, and mean time to recovery are examined alongside qualitative indicators such as cultural shifts, stakeholder satisfaction, and regulatory compliance. Furthermore, challenges and barriers to DevOps adoption in healthcare settings are identified, offering insights into strategies for overcoming these obstacles. By synthesizing empirical evidence and expert insights, this paper provides a comprehensive evaluation of the impact of DevOps practices in enhancing the agility, reliability, and innovation capabilities of U.S. healthcare systems

Implementation of a Patient Acuity Tool and Safe Staffing Model in an Outpatient Oncology Clinical Trials Unit.

Appropriate staffing in the outpatient oncology setting contributes to the delivery of quality care. Objective measures of acuity and nursing workload can assist with developing staffing models; however, measuring acuity in a.

Space exploration as a catalyst for medical innovations.

Aerospace research has a long history of developing technologies with industry-changing applications and recent history is no exception. The expansion of commercial spaceflight and the upcoming exploration-class missions to the Moon and Mars are expected to accelerate this process even more. The resulting portable, wearable, contactless, and regenerable medical technologies are not only the future of healthcare in deep space but also the future of healthcare here on Earth. These multi-dimensional and integrative technologies are non-invasive, easily-deployable, low-footprint devices that have the ability to facilitate rapid detection, diagnosis, monitoring, and treatment of a variety of conditions, and to provide decision-making and performance support. Therefore, they are primed for applications in low-resource and remote environments, facilitating the extension of quality care delivery to all patients in all communities and empowering non-specialists to intervene early and safely in order to optimize patient-centered outcomes. Additionally, these technologies have the potential to advance care delivery in tertiary care centers by improving transitions of care, providing holistic patient data, and supporting clinician wellness and performance. The requirements of space exploration have created a number of paradigm-altering medical technologies that are primed to revitalize and elevate our standard of care here on Earth.

Awareness of reporting practices and barriers to incident reporting among nurses

BackgroundAdequate incident reporting practices for clinical incident among nurses and even all healthcare providers in clinical practice settings is crucial to enhance patient safety and improve the quality of care delivery. This study aimed to investigate the level of awareness of incident reporting practices and identify the barriers that impact incident reporting among Jordanian nurses.MethodsA descriptive design using a cross-sectional survey was employed among 308 nurses in 15 different hospitals in Jordan. Data collection was conducted between November 2019 and July 2020 using an Incident Reporting Scale.ResultsThe participants showed a high level of awareness of the incident reporting with a mean score of 7.3 (SD = 2.5), representing 94.8% of the highest score. Nurses perceived their reporting practices at the medium level, with a mean score of 2.23 out of 4. The main reporting barriers included worrying about disciplinary actions, fearing being blamed, and forgetting to make a report. In regard to awareness of incident reporting, there were statistically significant differences in the mean for total awareness of the incident reporting system scores according to the type of hospital (p < .005*). In regard to self-perceived reporting practices, nurses working in accredited hospitals demonstrated statistically significant differences in self-perceived reporting practices (t = 0.62, p < .005).ConclusionsThe current results provide empirical results about perceived incident reporting practices and perceived barriers to reporting frequently. Recommendations are made to urge nursing policymakers and legislators to provide solutions for those barriers, such as managing staffing issues, nursing shortage, nurses’ empowerment, and fear of disciplinary actions by front-line nurse managers.

A time-motion study of community health workers delivering community-based primary health care in Neno District, Malawi

IntroductionCommunity health workers (CHWs) are vital resources in delivering community-based primary health care, especially in low-and-middle-income countries (LMIC). However, few studies have investigated detailed time and task assessments of CHW's work. We conducted a time-motion study to evaluate CHWs' time on health conditions and specific tasks in Neno District, Malawi.MethodsWe conducted a descriptive quantitative study utilizing a time observation tracker to capture time spent by CHWs on focused health conditions and tasks performed during household visits. We observed 64 CHWs between 29 June and 20 August 2020. We computed counts and median to describe CHW distribution, visit type, and time spent per health condition and task. We utilized Mood’s median test to compare the median time spent at a household during monthly visits with the program design standard time. We used pairwise median test to test differences in median time duration for health conditions and assigned tasks.ResultsWe observed 660 CHW visits from 64 CHWs, with 95.2% (n = 628) of the visits as monthly household visits. The median time for a monthly household visit was 34 min, statistically less than the program design time of 60 min (p < 0.001). While the CHW program focused on eight disease areas, pretesting with the observation tool showed that CHWs were engaged in additional health areas like COVID-19. Of the 3043 health area touches by CHWs observed, COVID-19, tuberculosis, and non-communicable diseases (NCDs) had the highest touches (19.3%, 17.6%, and 16.6%, respectively). The median time spent on sexually transmitted infections (STIs) and NCDs was statistically higher than in other health areas (p < 0.05). Of 3813 tasks completed by CHWs, 1640 (43%) were on health education and promotion. A significant difference was observed in the median time spent on health education, promotion, and screening compared to other tasks (p < 0.05).ConclusionThis study demonstrates that CHWs spend the most time on health education, promotion, and screening per programmatic objectives but, overall, less time than program design. CHWs deliver care for a broader range of health conditions than the programmatic design indicates. Future studies should examine associations between time spent and quality of care delivery.

A climate resilience maturity matrix for Canadian health systems.

Healthcare decision-makers are becoming increasingly aware that climate change poses significant threats to population health and continued delivery of quality care. Challengingly, responding to climate change requires complex, often expensive, and multi-faceted actions to limit new emissions from worsening climate trajectories, while investing in climate-resilient systems. We present a Climate Resilience Maturity Matrix that brings together both mitigation and adaptation actions into a high-level tool for health leaders, for supporting organizational review, assessment, and decision-making for climate change readiness. This tool is designed to (i) support leaders in Canadian health facilities and regional health authorities in designing mitigation and adaptation roadmaps, (ii) support decision-making for climate change-related strategic planning processes, and (iii) create a high-level overview of organizational readiness. This tool is intended to consolidate key data, provide a clear communication tool, allow for objective rapid baselining, enable system-level gap analysis, facilitate comparability/transparency, and support rapid learning cycles.

Women's health nurses' experiences of menopause: Considerations for nurse leaders.

Women's health nurses' experiences of menopause: Considerations for nurse leaders.

The impact on hospice quality after initiation of an internal palliative care program by a community oncology practice.

e18720 Background: Virginia Cancer Institute (VCI) participated in the Oncology Care Model (OCM) with an aim to improve cancer care quality. As part of OCM, VCI started a palliative care program (PC) in 2016 by partnering with a local palliative care provider. In September 2020, VCI overhauled PC moving away from outside provider (OPC) and created an internal program (IPC). Both programs managed care from VCI oncologist referrals to PC until patient’s hospice start or practice discharge. This study describes the methods or changes from OPC to IPC and the resulting difference in hospice quality measure performance. Methods: Under OPC, services were provided half-day per week in office from a PC nurse practitioner (NP). IPC changed to a PC NP employed by VCI who provided services 5 days per week with office, hospital and telemedicine options. IPC added multiple PC education, communication touchpoints with oncologists and practice staff. IPC provided reminders to VCI physician teams about the availability of in-house PC services and the benefits of early engagement. Along with the oncologists, IPC continued goals of care discussions with patients and family to ensure patients’ desires and needs were met. OPC hospice referrals from PC went to a single hospice group. IPC added a network of multiple hospice groups. Retrospective claims review of OCM performance periods (PP) 1-8 (Jul 2016 – Dec 2020) for OPC and OCM PP 9-10 (Jul 2020 – Dec 2021) for IPC was performed and excluded patients with incomplete hospice claims. Primary endpoint was difference between OPC and IPC in OCM-3 quality: proportion of OCM patients who died during their episode with 3 or more days hospice immediately prior to death. Secondary endpoint was the difference in proportions of OPC and IPC with any hospice length of stay. Z-test between 2 proportions was used to calculate significance. Results: There were 871 and 197 OCM-3 eligible patients reviewed from OPC and IPC respectively. OCM-3 quality performance was 48.1% OPC and 62.4% IPC, p &lt; 0.01. Any hospice performance was 65.8% OPC and 78.7% IPC, p &lt; 0.01. The OCM-3 goal throughout for maximum quality score was 60%. Performance improvement started in the first IPC period (PP9) and was greater in the second IPC period (PP10). Conclusions: Results showed a significant improvement in OCM performance measures between OPC and IPC over a short period of 10 months. After IPC, practice met the OCM-3 goal. The data is limited to latest available OCM reconciliation claims and may be refreshed when additional OCM data is released. Although specific cause and effect was not assessed, the authors attribute quality improvement to the implementation of an internal, full-time PC NP. This expanded PC access for patients and increased communication between patients and providers. We believe that, as a result, the quality of care delivery improved.