title: Expanding the reach of decision and communication aids in a breast care center: a quality improvement study.
abstract: OBJECTIVE
  One academically based breast cancer clinic implements decision and communication aids as part of routine clinical care. This quality improvement study aimed to expand reach of these supportive materials and services with budget-neutral program changes.
  
  
  METHODS
  We used program theory and continuous quality improvement to design changes to our program. We calculated reach as the number of new patient visits for which we administered decision and communication aids. We compared reach before and after the program changes.
  
  
  RESULTS
  Program changes included: reassigning program outreach tasks from over-committed to under-utilized personnel; deploying personnel in floating rather than fixed schedules; and creating a waitlist so service delivery was dynamically reallocated from overbooked to underbooked personnel. Before these changes, we reached 208 visitors with decision aids, and 142 visitors with communication aids. Changes were associated with expanded reach, culminating in program year 2008 with the delivery of 936 decision aids and 285 communication aids.
  
  
  CONCLUSIONS
  We observed over a fourfold increase in decision aid reach and a twofold increase in communication aid reach. We attribute increases to recent program changes.
  
  
  CONCLUSIONS
  This study illustrates how program theory and quality improvement methods can contribute to expanded reach of decision and communication aids.
authors.affiliation: University of California, San Francisco, USA. jeff.belkora@ucsfmedctr.org
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Belkora
authors.forename: Alexandra
authors.initials: A
authors.lastname: Teng
authors.forename: Shelley
authors.initials: S
authors.lastname: Volz
authors.forename: Meredith K
authors.initials: MK
authors.lastname: Loth
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Esserman
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D003142:Communication; D020000:Decision Support Systems, Clinical / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010817:Physician-Patient Relations; D016730:Program Development; D015397:Program Evaluation; D036301:Qualitative Research; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D013637:Tape Recording; D016387:Women's Health