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A Patient-Inspired Quality Improvement Initiative for Pituitary Adenoma Care

Published online by Cambridge University Press:  01 October 2020

Irena Druce
Affiliation:
Department of Medicine, Division of Endocrinology and Metabolism, University of Ottawa Ottawa, ON, Canada
Mary-Anne Doyle
Affiliation:
Department of Medicine, Division of Endocrinology and Metabolism, University of Ottawa Ottawa, ON, Canada
Amel Arnaout
Affiliation:
Department of Medicine, Division of Endocrinology and Metabolism, University of Ottawa Ottawa, ON, Canada
Dora Liu
Affiliation:
Department of Medicine, Division of Endocrinology and Metabolism, University of Ottawa Ottawa, ON, Canada
Fahad AlKherayf
Affiliation:
Department of Surgery, Division of Neurosurgery, University of Ottawa, Ottawa, ON, Canada Ottawa Hospital Research Institute Ottawa, ON, Canada
Charles Agbi
Affiliation:
Department of Surgery, Division of Neurosurgery, University of Ottawa, Ottawa, ON, Canada
Erin Keely
Affiliation:
Department of Medicine, Division of Endocrinology and Metabolism, University of Ottawa Ottawa, ON, Canada
Janine Malcolm*
Affiliation:
Department of Medicine, Division of Endocrinology and Metabolism, University of Ottawa Ottawa, ON, Canada
*
Correspondence to: Janine Malcolm, Department of Medicine, Division of Endocrinology and Metabolism, University of Ottawa, 1967 Riverside Dr. Ottawa, ON, K1H 7W9, Canada. Email: jamalcolm@toh.ca

Abstract:

Background:

Pituitary adenomas (PAs) are common and often require complex multidisciplinary care with multiple specialists. This may result in a healthcare system that is challenging for patients to navigate. Audits of care at our institution revealed opportunities for improvement to better align care with patients’ needs.

Methods:

A quality improvement initiative that incorporated a patient advisory committee of patients who had received treatment for PA at our center and their family members were used to help identify opportunities for improvement. The patient-identified gaps in care included the need to coordinate and minimize appointments and the desire for better communication and education. Based on this information, changes were implemented to the pituitary program, including increasing access to the Multidisciplinary Clinic and developing a standardized and centralized triage process.

Results:

A pre- and post-intervention analysis consisting of retrospective chart reviews revealed that these changes had an impact on wait times for first assessment, and a significant shift in the location of this first visit – with a larger proportion of patients being seen in the Multidisciplinary Clinic after an intervention.

Conclusions:

We demonstrate that patient involvement, beyond individual patient–physician interactions, can lead to meaningful and observable changes, and can improve the quality of care for PA.

Résumé :

RÉSUMÉ :

Initiative d’amélioration de la qualité des soins de l’adénome hypophysaire, éclairée par des patients.

Contexte :

Les adénomes hypophysaires sont une forme fréquente de tumeur et ils nécessitent souvent l’intervention de nombreux spécialistes et des plans de soins pluridisciplinaires complexes. Une telle organisation peut donner aux patients l’impression qu’il est difficile de se retrouver dans un tel système de soins de santé. Des examens de vérification des soins, réalisés dans l’établissement des auteurs ont révélé différentes possibilités d’amélioration des soins répondant davantage aux besoins des patients.

Méthode :

Il s’agit d’une initiative d’amélioration de la qualité des soins, mise sur pied dans l’établissement en question, à laquelle participait un comité consultatif composé de patients eux-mêmes traités pour un adénome hypophysaire ainsi que de membres de leur famille, afin de cerner des possibilités d’amélioration des soins. Les lacunes dégagées par les patients, relativement aux soins comprenaient le besoin de coordination des rendez-vous et de réduction de leur nombre, ainsi que le désir de meilleures communications et d’une éducation plus appropriée. Par la suite, des changements ont été apportés au programme de traitement des troubles hypophysaires, dont un accès accru au centre pluridisciplinaire de soins et l’élaboration d’un processus uniforme et centralisé de triage.

Résultats :

Une analyse de type avant et après l’intervention, consistant en un examen rétrospectif de dossiers, a révélé que ces changements avaient déjà eu une incidence sur le temps d’attente de la première évaluation et s’étaient traduits par un changement notable du lieu de cette première consultation, suivi notamment d’une augmentation du nombre de patients vus au centre pluridisciplinaire de soins après l’intervention.

Conclusion :

La démarche a démontré que la participation des patients, au-delà des simples relations entre patients et médecins, peut conduire à des changements observables et importants, susceptibles d’améliorer la qualité des soins de l’adénome hypophysaire.

Type
Original Article
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press on behalf of The Canadian Journal of Neurological Sciences Inc.

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