The Development and Clinical Impact of an Innovative Palliative Care Lever Tool for Individuals With Idiopathic Pulmonary Fibrosis: A Quality Improvement Project.

Abstract

Background: Palliative care (PC) is underutilized in the idiopathic pulmonary fibrosis (IPF) patient population, particularly in outpatient settings, despite high symptom burden and complex care needs. There is no clinician consensus for the most effective method of integrating PC into routine medical visits for this patient population, despite acknowledgement of its benefits. The purpose of this quality improvement (QI) project was to pilot an adapted nurse practitioner-led standardized PC lever tool for IPF in an outpatient clinic and evaluate the secondary PC referral rates during the implementation period.

Design: The lever tool was implemented over a 3-month period. De-identified patient health information from the health system's electronic medical record system was used to compare referrals to PC prior to and during the implementation of the lever tool.

Results: The established workflow for the nurse practitioner-led implementation of the tool was feasible. There were increased PC referrals and increased PC encounters during the QI period, however the results were not statistically significant.

Conclusions: The findings of this QI project add to the limited existing literature evaluating PC referral methods for individuals with IPF in an outpatient setting. Further, the development process and workflow utilized confirms the feasibility of employing the nursing workforce to support the care needs of the IPF patient population.