title: A national facilitation project to improve primary palliative care: impact of the Gold Standards Framework on process and self-ratings of quality.
abstract: BACKGROUND
  Improving quality of end-of-life care is a key driver of UK policy. The Gold Standards Framework (GSF) for Palliative Care aims to strengthen primary palliative care through facilitating implementation of systematic clinical and organisational processes.
  
  
  OBJECTIVE
  To describe the general practices that participated in the GSF programme in 2003-5 and the changes in process and perception of quality that occurred in the year following entry into the programme, and to identify factors associated with the extent of change.
  
  
  METHODS
  Participating practices completed a questionnaire at baseline and another approximately 12 months later. Data were derived from categorical questions about the implementation of 35 organisational and clinical processes, and self-rated assessments of quality, associated with palliative care provision.
  
  
  METHODS
  1305 practices (total registered population almost 10 million). Follow-up questionnaire completed by 955 (73.2%) practices (after mean (SD) 12.8 (2.8) months; median 13 months).
  
  
  RESULTS
  Mean increase in total number of processes implemented (maximum = 35) was 9.6 (95% CI 9.0 to 10.2; p<0.001; baseline: 15.7 (SD 6.4), follow-up: 25.2 (SD 5.2)). Extent of change was largest for practices with low baseline scores. Aspects of process related to coordination and communication showed the greatest change. All dimensions of quality improved following GSF implementation; change was highest for the "quality of palliative care for cancer patients" and "confidence in assessing, recording and addressing the physical and psychosocial areas of patient care".
  
  
  CONCLUSIONS
  Implementation of the GSF seems to have resulted in substantial improvements in process and quality of palliative care. Further research is required of the extent to which this has enhanced care (physical, practical and psychological outcomes) for patients and carers.
authors.affiliation: Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK. jeremy.dale@warwick.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Dale
authors.forename: M
authors.initials: M
authors.lastname: Petrova
authors.forename: D
authors.initials: D
authors.lastname: Munday
authors.forename: J
authors.initials: J
authors.lastname: Koistinen-Harris
authors.forename: R
authors.initials: R
authors.lastname: Lall
authors.forename: K
authors.initials: K
authors.lastname: Thomas
mesh_terms: D004739:England; D005194:Family Practice / Q000592:standards; D006801:Humans; D007494:Ireland; D010043:Outcome and Process Assessment, Health Care; D010166:Palliative Care / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care