My career goal is to mature as an independent health services researcher, with a focus on quality and palliative care, to improve the experience of patients with serious and chronic illness and their caregivers. Palliative care is a newer clinical discipline focused on improving quality of life for all patients, independent of prognosis. Palliative care has achieved remarkable growth, with clinical services present in 66% of all hospitals. Despite such growth, a standardized clinical approach does not yet exist. Such an approach requires evaluating which care processes, recommended by published quality measures, improve patient-centered outcomes the most. Then, the care processes and associated quality measures with the greatest impact can be prioritized. We have developed the infrastructure to perform this investigation. Specifically, I led the development of QDACT-PC (Quality Data Collection Tool Palliative Care), a point-of-care, iPad(tm)-based data collection system that simultaneously populates a registry of care processes, quality measure adherence, and patient and health system outcomes. In September 2013, we were awarded an AHRQ R18 grant to implement QDACT-PC nationally in the Palliative Care Research Cooperative Group (PCRC), the first national research collaborative for palliative care. Analysis aims were reserved by my mentor and the PI of that proposal, Dr. Amy Abernethy, for this K08 application. My research goal is to use this quickly growing registry to explore the impact of quality measure adherence on outcomes in the palliative care setting. Under the guidance of my mentors, I will first, I will describe variability in clinician adherence to a set of 20 core palliative care qualiy measures among 1000 patients. Then, I will use quantitative and qualitative methods to determine the relationship between adherence to a set of palliative care quality measures and patient-reported outcomes, including satisfaction with care, quality of life, and symptom relief. Last, I will investigate the relationship between adherence to a set of quality measures and health service utilization, as measured by 30-day readmission rates, length of stay, and overall health care costs. Together, these aims alongside a robust career development plan and dedicated mentorship, will prepare me for an R01-level submission prospectively testing the identified core set on patient-centered outcomes.

Public Health Relevance

There remains no tested set of prioritized quality measures in palliative care to guide best practices in the field. I, under the guidance of my mentors, will analyze the first national registry of quality measures in palliative care to understand which measures, when adhered to, improve patient-centered and health system outcomes of importance.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08HS023681-05
Application #
9778807
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Willis, Tamara
Project Start
2015-09-30
Project End
2020-09-29
Budget Start
2019-09-30
Budget End
2020-09-29
Support Year
5
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Duke University
Department
Other Clinical Sciences
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Swetz, Keith M; Kamal, Arif H (2018) Palliative Care. Ann Intern Med 168:ITC33-ITC48
Kamal, Arif H; Kirkland, Kathryn B; Meier, Diane E et al. (2018) A Person-Centered, Registry-Based Learning Health System for Palliative Care: A Path to Coproducing Better Outcomes, Experience, Value, and Science. J Palliat Med 21:S61-S67
Ast, Katherine; Kamal, Arif H; Lindley, Lisa C et al. (2018) Maintaining the Momentum of Measuring What Matters: Overcoming Hurdles To Develop Electronic Clinical Quality Measures. J Palliat Med 21:123-124
Wiesenthal, Alison C; Patel, Sandip P; LeBlanc, Thomas W et al. (2018) Top Ten Tips for Palliative Care Clinicians Caring for Cancer Patients Receiving Immunotherapies. J Palliat Med 21:694-699
Johnson, Alyson M; Spaete, Joshua P; Jowell, Paul S et al. (2018) Top Ten Tips Palliative Care Clinicians Should Know About Interventional Symptom Management Options When Caring for Patients with Gastrointestinal Malignancies. J Palliat Med 21:1339-1343
Hochman, Michael J; Yu, Yinxi; Wolf, Steven P et al. (2018) Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies. J Pain Symptom Manage 55:82-88.e1
Davidson, Brittany A; Moss, Haley A; Arquiette, Jaclyn et al. (2018) Top Ten Tips Palliative Care Clinicians Should Know When Caring for Patients with Endometrial Cancer. J Palliat Med 21:857-861
Hudson, Kathryn Elizabeth; Wolf, Steven Paul; Samsa, Gregory P et al. (2018) The Surprise Question and Identification of Palliative Care Needs among Hospitalized Patients with Advanced Hematologic or Solid Malignancies. J Palliat Med 21:789-795
Bull, Janet; Kamal, Arif H; Harker, Matthew et al. (2017) Tracking Patients in Community-Based Palliative Care through the Centers for Medicare & Medicaid Services Healthcare Innovation Project. J Palliat Med 20:1231-1236
Kamal, Arif H (2017) Redesigning Oncology Care Delivery: Early Wins, Lessons Learned, and a Roadmap. Med Care 55:871-872

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