title: Improving the quality of care for patients diagnosed with glioma during the perioperative period.
abstract: OBJECTIVE
  Although there is agreement on the oncologic management of patients with glioma, few guidelines exist to standardize other aspects of care, including supportive care.
  
  
  METHODS
  A quality improvement (QI) project was chartered to improve the care provided to patients with glioma. A multidisciplinary team was convened and identified 10 best-practice measures. Using a plan-do-study-act framework, the team brainstormed and implemented various improvement interventions between June 2011 and October 2012. Statistical process control charts were used to evaluate progress. A dashboard of quality measures was generated to allow for ongoing measurement and reporting.
  
  
  RESULTS
  The retrospective assessment phase consisted of 43 patients with diagnosis of glioma. A manual medical record review for these patients showed that compliance with 10 best-practice measures ranged from 23% to 100%. Several factors contributed to less-than-ideal process performance, including poor communication among disciplines and lack of familiarity with the larger system of care. After implementing improvement interventions, performance was measured in 96 consecutive patients with glioma. The proportion of patients who met criteria for 10 practice measures significantly improved (pre-QI work, 63%; post-QI work, 85%; P = .003). The largest improvement was observed in the measure assessing for preoperative notification of the neuro-oncology program (pre-QI work, 39%; post-QI work, 97%; P < .001).
  
  
  CONCLUSIONS
  QI principles were used by a multidisciplinary team to improve the quality of care for patients with glioma during the perioperative period. Leadership involvement, ongoing dialogue across departments, and reporting of system performance were important for sustaining process improvements.
authors.affiliation: Dartmouth-Hitchcock Medical Center; Norris Cotton Cancer Center; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon; and Geisel School of Medicine, Hanover, NH.
authors.forename: Natalie B V
authors.initials: NB
authors.lastname: Riblet
authors.affiliation: Dartmouth-Hitchcock Medical Center; Norris Cotton Cancer Center; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon; and Geisel School of Medicine, Hanover, NH.
authors.forename: Evelyn M
authors.initials: EM
authors.lastname: Schlosser
authors.affiliation: Dartmouth-Hitchcock Medical Center; Norris Cotton Cancer Center; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon; and Geisel School of Medicine, Hanover, NH.
authors.forename: Karen
authors.initials: K
authors.lastname: Homa
authors.affiliation: Dartmouth-Hitchcock Medical Center; Norris Cotton Cancer Center; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon; and Geisel School of Medicine, Hanover, NH.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Snide
authors.affiliation: Dartmouth-Hitchcock Medical Center; Norris Cotton Cancer Center; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon; and Geisel School of Medicine, Hanover, NH.
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Jarvis
authors.affiliation: Dartmouth-Hitchcock Medical Center; Norris Cotton Cancer Center; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon; and Geisel School of Medicine, Hanover, NH.
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Simmons
authors.affiliation: Dartmouth-Hitchcock Medical Center; Norris Cotton Cancer Center; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon; and Geisel School of Medicine, Hanover, NH.
authors.forename: David H
authors.initials: DH
authors.lastname: Sargent
authors.affiliation: Dartmouth-Hitchcock Medical Center; Norris Cotton Cancer Center; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon; and Geisel School of Medicine, Hanover, NH.
authors.forename: Linda P
authors.initials: LP
authors.lastname: Mason
authors.affiliation: Dartmouth-Hitchcock Medical Center; Norris Cotton Cancer Center; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon; and Geisel School of Medicine, Hanover, NH.
authors.forename: Tobi J
authors.initials: TJ
authors.lastname: Cooney
authors.affiliation: Dartmouth-Hitchcock Medical Center; Norris Cotton Cancer Center; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon; and Geisel School of Medicine, Hanover, NH.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Kennedy
authors.affiliation: Dartmouth-Hitchcock Medical Center; Norris Cotton Cancer Center; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon; and Geisel School of Medicine, Hanover, NH camilo.e.fadul@hitchcock.org.
authors.forename: Camilo E
authors.initials: CE
authors.lastname: Fadul
mesh_terms: D019985:Benchmarking; D001932:Brain Neoplasms / Q000601:surgery*; D019091:Critical Pathways / Q000592:standards; D005260:Female; D005910:Glioma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning / Q000458:organization & administration; D063868:Patient Outcome Assessment; D019990:Perioperative Care / Q000592:standards*; D058996:Quality Improvement; D012189:Retrospective Studies