Project Description Overview The Washington, D.C. Regional Quality Improvement Collaborative (DC-QuIC) was launched by the Washington, DC Area Geriatric Education Center Consortium (WAGECC), RAND, The Washington Home Center for Palliative Care Studies, and the D.C. Partnership to Improve End-of-Life Care. With funding by the Stewart Trust for three years, DCQuIC implemented quality improvement team activities to enhance care for those with serious, chronic illness in a variety of care settings. Local health care provider organizations formed teams to work intensely with expert faculty to implement best practices and craft new solutions to improving care for individuals with serious chronic illness. Each participating team has set its own goals for clinical improvement and works together to exchange ideas and strategies for making these improvements happen. The participating teams are multidisciplinary and multicultural, and are exploring ways of improving care to the region’s multi-ethnic population. Mission In this Collaborative, participating Washington, DC regional health care organizations are working to improve palliative care delivered to area residents living with serious, chronic illness. The target population includes those who are eligible for hospice under the Medicare hospice benefit as well as those who are not. The latter group may be in the early, “upstream” phases of illness or have uncertain prognoses. We are working together to achieve the Collaborative goals by sharing established insights and educated possibilities, setting specific goals for improvement, sharing methods for organizational change, implementing iterative tests of change, and measuring progress toward meeting our goals. We have been laying the groundwork for ongoing, collaborative activities that has resulted in improved quality of care across Washington, DC area institutions, not just within organizations participating in the Collaborative. Goals The overarching Collaborative goal is to improve access to, and quality of, palliative care services delivered to patients with serious, chronic illness in the Washington, DC regional area through the use of evidence-based practices and rapid-cycle quality improvement. This work is beginning early in the course of living with an eventually fatal illness where possible. The Recruitment Process Organizations that have a palliative care and/or hospice component are contacted and sent a letter of invitation describing the QI initiative and objectives. Applicants describe the topic/issues for quality improvement work; list team members to date and their discipline: list the name and contact information of the Senior leader, i.e., the senior level medical or administrative person, that the team will rely on for guidance, resources, problem-solving, and support. Once the team information is complete, team members are invited to a QI learning session, or, a learning session is sponsored at their site. Teams are taught the QI process and how to work together to accomplish their respective goals and objectives. The Team QI Process (in brief) Teams define the AIM, or what the organization’s team hopes to achieve during the Collaborative. Then they select team members, and insure that the composition and expertise of the interdisciplinary team match the aim that was selected. Teams include the people needed to get improvement underway. Teams usually meet every week or two during the Collaborative’s project period. Most teams have focused on such areas as: pain and other symptom management, advance care planning, communication with patients and families, and continuity and transfer issues. Other topics that enhance patient quality of life such as spiritual and multicultural issues, and peg tube feeding have also been addressed by teams. Teams are invited to a learning session where they may send members who can most effectively work together, learn the methodology, and plan for action upon return to their work base. The Learning Session(s) Learning Sessions provide team members with information to guide them through a “quick turnaround” QI process; offer a venue for information exchange; and support them with expertise from Quality improvement leadership faculty experts. Faculty from a variety of settings (see faculty list) are invited to join and assist the teams as they work through their approach to the QI process and assist them as they choose their aims, and discuss potential problems and concerns that may be barriers within their organizations to achieving their goals. Faculty also visit sites and work with individual teams. Further, at an organization’s request, seminars on specific QI topics may be offered as an in-service to further team learning, but also provide a format for overall organizational education on an important topic in palliative care. The Stewart Trust has provided funding for three years (2001-2004) for the worthwhile project described above. The Center for Palliative Care Studies (Dr. Joanne Lynn, Director) is undergoing a national Quality Improvement effort that supports teams nationwide. At the end of the third year, the DC regional Collaborative QI teams will be invited to join the national group to continue their valuable work and offer their accomplishments to the national collaborative for sharing and discussion. Meanwhile, the D.C. Regional Collaborative will continue to impact quality improvement in a region whose multi-ethnic population continues to grow and is badly in need of quality healthcare services, especially at end of life. Unexpected outcomes of the QI Project: The regional interest in Quality Improvement activities stemming from the project inspired an annual Forum on the topic. The first Forum was an outstanding success with 122 attendees and 14 team leaders presenting. Although 14 teams were advanced enough to present at the Forum, 24 teams had formed and were in different stages of development at the time of the Forum. Although some teams were not able to make significant progress because of staff turnover, the remaining team members reported to have learned a great deal about QI and intend to try again as staffing and time permit. One participating hospital instituted a Palliative Care Consultation Unit as a result of the project’s positive impact at the hospital. Members of an inner city hospital QI team attended a national conference on Quality Improvement to learn more about the topic and to further develop their already successful team activities. A VA hospital offered a full day of learning on the topic of QI. Additions to WAGECC course curriculum were based on the success of the project and interest in the topic by participants. Community interest in QI was such that two senior services organizations are in the process of forming teams as a part of this project. NOTE: The following team reports were provided for the website in Spring 2004. Therefore, the information provided should be considered a “work in progress” for each team. Team leaders will share their experiences if you wish to write to the team “Contact.” <top> Click on the Project Name to view the data. TEAM PROJECT Washington DC Veterans Affairs Medical Center: Joy Laramie, NP; Mary Ann Wentzel, MSW; Joan Trelease, CRNH; Elizabeth L. Cobbs MD Evolution of a Comprehensive Palliative Care Program at Washington , DC VA Medical Center Washington DC Veterans Affairs Medical Center: Raya Kheirbek, MD; Karen The Effect of Expanding the Palliative Care Consult Team on Location of Death in a Veterans Affairs Medical Center Washington, DC Veterans Affairs Medical Center: Joy Laramie, NP; Mary Ann Wentzel, MSW; Raya Kheirbek, MD; Susan Beale, Sammy Khatib Effect of a Quality Improvement Initiative to Promote Advance Care Planning in the Nursing Home Kaiser Permanente/ Holy Cross Palliative Care Partnership: Ruth Kevess-Cohen, MD; Lauren Stein, ST, CM; Kathy Waters, CM Tube Feeding Project Kaiser Permanente/Holy Cross Palliative Care Partnership: Lee Schwab, MD; John Pollack, chaplain; Lesley Rowland, SW; Stella Ross, RN, CM Advance Care Planning Project Kaiser Permanente/ Holy Cross Palliative Care Partnership: Margaret Hadley, RN; Andrea Ferris, RN; Sue St. Aubin, RN; Linda Haynes, RN; Jeanne Stillson,; Niki Miller; Marcy Pagliaro Coordinated Care Plan Kaiser Permanente/Holy Cross Palliative Care Partnership: Linda Arnold, Palliative Care Chaplain; Jennifer Bova, MSWSue Cobley, RN, ICU; Y. Louise Hicks, Chaplain; Becky Johnson, RN, Oncology; Evelyn Nuamah, RN, Case Manager; Susan Roach, RN, Parrish Nurse Coordinator Cultural/Religious Sensitivity & Patient Care Kaiser Permanente Holy Cross Palliative Care Partnership: Dr. Elise Riley*; Sue Fortuna, RN; Dr. Robert Gerard; Cheryl Murphy, OT; Ann November-Moss, RT; Terry Smith, CM ICU Goals of Care and Communication Kaiser Permanente/Holy Cross Palliative Care Partnership: Robyn Anderson, MD; Joy Livingston, RN; Margie Anthony, RN; Steve Kariya, MD; Dianna Wildeson, RN Pain Management Hadley Memorial Pain Management:Jay Quintana;. Dr. Al-Khouri, Jacque Billingslea, Sharon Mills, Susan Harper, Beth Michaels, Newly formed pain team, PFFT Committee, Patient care coordinators   Columbia Senior Center: Fiona Druy RNNP, MPH; Case Managers at Columbia Senior Center; DC Office of Aging Assessment Case Management Program Advance Care Planning The Washington Home: Elizabeth Tabod, RN team leader, Carrie Vestal LGSW, and others Advance Care Planning <top>