New knowledge is not necessarily readily applied in medicine, even when there is evidence of its effectiveness.
As a result of the gap between knowing and doing, policy makers, professional care providers, patients and their families have benefited too little from new developments. Implementation research has developed models for stepwise implementation but it is still unclear which strategies are effective for whom and which factors influence the effectiveness of implementation strategies.
From the point of view of implementation sciences changing palliative care is a major challenge, since adequate organization of palliative care requires collaboration between a range of different professionals and healthcare organizations. Besides, as a consequence of the ageing population, the number of people in need for cancer and dementia palliative care will rise. Therefore we will focus on implementation strategies in palliative care.
The objectives of this project are: to find optimal strategies for implementing quality indicators to improve the organisation of palliative cancer and dementia care in Europe, and to pilot study the effectiveness of these strategies, and factors influencing their effectiveness. This information will be used to build a conceptual implementation model applicable across diverse healthcare settings and that allows rigorous assessment of the effectiveness of implementation strategies.
By this means we aim to improve knowledge on how and to what extent health interventions can fit within real-world clinical practice, including knowledge whether the implementation remained faithful to the original conceptualisation and intent of the quality indicator.
Therefore we want to take the following steps to develop implementation strategies:
The overall aim of this project is to develop optimal implementation strategies for using quality indicators to improve the organization of palliative cancer and dementia care in Europe and to study factors influencing the effectiveness of the strategies.
We will focus on the implementation process and concentrate the Work Packages on: the organization of palliative care, the development of a set of setting-specific implementation strategies including an interactive website and instruction by consultants, the evaluation of the use of selected strategies to improve the organization of palliative care and factors influencing the effectiveness of the implementation strategies.
This information will be used to build a conceptual model that should be applicable across diverse healthcare settings and that allows rigorous assessment of the effectiveness of implementation strategies. Dissemination of the results will be enhanced by involving stakeholders, including two European networks related to the subject of this implementation process study.
It is widely known that even evidence-based interventions do not implement themselves. As a result, there is a know-do gap between clinical research and everyday clinical practice. Our project will contribute to a better understanding of implementation strategies by systematically studying the process of implementation of quality indicators in a specific field of an urgent societal problem; the organization of palliative care for the rapidly growing group of cancer and dementia patients. We will use the 'case' of palliative care as a model to study the process of implementation in the organization of complex, mulit-professional holistic care. Relevant stakeholders will be involved in all phases of the implementation process.
A set of QIs has been developed and is expected to be published in a scientific paper in 2014. This set of QIs has been used in the pilot test we have performed in five countries (NL, DE, UK, IT, NO), in four types of settings (hospitals, hospices, nursing homes, primary care). In each of these settings, a consultant invited the professional team to assess the quality of their organization with the help of the set of QIs and to chose improvement topics and aims.
Based on quality improvement steps (Grol et al) the teams improved the organization of their setting. Finally, the effects were measured with the QI set. The results of this implementation study will be available in 2014. This implies that at the end we will have a set of QIs to assess the quality of the organization of palliative care in all kind of settings and countries; an overview of barriers and incentives with regard to implementing quality improvement projects in the organization of palliative care as well as effective implementation strategies.
In the future, also other countries can use our set of QIs and the manual that describes how to use them and how to start improvement projects. We do know that often professionals want to change, but do not want to be changed. For that reason, the use of QIs should always start as a way to provide internal mirror information: as long as using QIs and transparency are no daily practice, the QIs should not be used by external parties to make judgements, but should be used by the professionals themselves.
In the end our project will contribute to a better understanding of implementation strategies by systematically studying the process of implementation of quality indicators and improvement projects in a specific field of an urgent societal problem; the organization of palliative care for the rapidly growing group of patients with cancer and patients with dementia.
Our ‘case’ of palliative care for this specific group of patients can also be used as a starting point for QI development and implementation in other groups of patients. Also after the IMPACT project has ended, we want to collect data of those settings that will use our set of QIs. A larger data set will enable comparisons, case-mix adjustments and further studies on this rich material.
We will also strive for dissemination in other European countries, and other continents. Our set of QIs has already been used in Indonesia, and parties from several Asian and African countries have shown interest to cooperate and use the QIs.
IMPACT project flyer ( 1.10MB)
"The IMPACT project" Yvonne Engels, Assistant Professor of pain and palliative medicine and international project coordinator; Myrra Vernooij-Dassen, Professor and Chair Interdem-European Research Group on INTERventions in DEMentia care.