title: Quality improvement in cancer symptom assessment and control: the Provincial Palliative Care Integration Project (PPCIP).
abstract: BACKGROUND
  The Provincial Palliative Care Integration Project (PPCIP) was implemented in Ontario, Canada, to enhance the quality of palliative care delivery. The PPCIP promoted collaboration and integration across service sectors to improve screening and assessment, palliative care processes, as well as clinician practice and outcomes for cancer patients.
  
  
  OBJECTIVE
  The project involved 1) implementation of the Edmonton Symptom Assessment System (ESAS) for symptom screening, 2) use of "rapid-cycle change" quality improvement processes to improve screening and symptom management, and 3) improvements in integration and access to palliative care services.
  
  
  METHODS
  Symptom scores were collected and made accessible to the care team through a web-based tool and kiosk technology, which helped patients enter their ESAS scores at each visit to the regional cancer center or at home with their nurse. Symptom response data were gathered through clinical chart audits.
  
  
  RESULTS
  Within one year of implementation, regional cancer centers saw improvements in symptom screening (54% of lung cancer patients), symptom control (69% of patients with pain scores and 31% of patients with dyspnea scores seven or more were reduced to six or less within 72 hours), and functional assessment (23% of all patients and 64% of palliative care clinic patients). ESAS screening rates reached 29%, and functional assessment reached 26% of targeted home care patients.
  
  
  CONCLUSIONS
  The PPCIP demonstrated that significant strides in symptom screening and response can be achieved within a year using rapid-cycle change and collaborative approaches. It showed that both short- and long-term improvement require ongoing facilitation to embed the changes in system design and change the culture of clinical practice.
authors.affiliation: Policy Research & Analysis, Cancer Care Ontario, Toronto, Ontario, Canada. julie.gilbert@cancercare.on.ca
authors.forename: Julie E
authors.initials: JE
authors.lastname: Gilbert
authors.forename: Doris
authors.initials: D
authors.lastname: Howell
authors.forename: Susan
authors.initials: S
authors.lastname: King
authors.forename: Carol
authors.initials: C
authors.lastname: Sawka
authors.forename: Erin
authors.initials: E
authors.lastname: Hughes
authors.forename: Helen
authors.initials: H
authors.lastname: Angus
authors.forename: Deborah
authors.initials: D
authors.lastname: Dudgeon
mesh_terms: D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D009864:Ontario / Q000453:epidemiology; D010146:Pain / Q000453:epidemiology*; D059408:Pain Management / Q000592:standards* / Q000706:statistics & numerical data; D010147:Pain Measurement / Q000592:standards / Q000706:statistics & numerical data; D010166:Palliative Care / Q000592:standards* / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D058996:Quality Improvement / Q000706:statistics & numerical data*; D016896:Treatment Outcome