The New York City Palliative Care Quality Improvement Collaborative

Background: Care for persons living with fatal chronic conditions is expensive and challenging, and can be unreliable. A quality improvement collaborative was conducted to develop capacity among health care providers in a single geographic area-New York City-to apply quality improvement methodology to palliative care services. Methods: The Palliative Care Quality Improvement Collaborative (PC-QuIC) modified the Institute for Healthcare Improvement's Breakthrough Series model by delivering four year-long implementation cycles, with 18-24 teams in each wave and 82 teams overall. Results: Substantial improvements were noted in most of the team projects (advance care planning, pain, family support, coordination of care), and substantial gains were made in familiarity with continuous quality improvement (CQI) techniques and in building palliative care programs and networks. Discussion: Collaborative rapid-cycle QI projects in a limited geographic area can be efficient in building and sustaining improved care for persons nearing the end of their lives, especially when the work involves the broad range of organizations that care for this patient population. PC-QuIC's experience illustrates the growing strength of palliative care services, but also demonstrates the challenges that confront further refinement and expansion of high-quality palliative care.