Improving the quality of care for patients diagnosed with glioma during the perioperative period

Abstract

Purpose: 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).

Conclusion: 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.

Figure 1.

Process flowchart for the acute care of patients with glioma (postintervention phase). NOTE. Codes refer to current procedural terminology codes for glioma surgery. Admit, hospital admission; appt, appointment; d/c, discharge; EMR, electronic medical record; ER, emergency room; N/O, neuro-oncology; N/S, neurosurgery; onc, oncology.

Figure 2.

Individual values and moving range chart of percent standards of care achieved by patients with glioma before and after quality improvement (QI) work. Control limits (CLs) are set at three sigma (pre-QI CL, 0% to 100%; post-QI CL, 50% to 100%). NOTE. Ovals indicate special-cause events (statistically significant change in underlying process whereby ≥ one point goes beyond CLs). Data not collected January through May 2011.

Figure 3.

Proportion of patients with glioma who met criteria for individual best-practice measures before and after quality improvement initiative, from January to December 2010 and June 2011 to September 2013. AED, antiepileptic drug; DC, discharge. (*) P = .01; (†) P < .001; (‡) P = .001.