University of Texas Southwestern Medical Center
Presentation Abstract
Implementing a Quality Improvement Project to Increase Access to Dietitian Services in a Resource Poor Setting: Challenges and Opportunities
Patients with gastrointestinal (GI) cancers have among the highest rates of malnutrition. Early identification and dietary interventions in patients with GI cancers have been successful in easing these burdens with improved outcomes. In a resource-poor setting, access to dietitian services can be delayed for the patients. Quality improvement (QI) projects are comprehensive and multidisciplinary analyses of current practices with the aim of implementing quantifiable changes. Using QI modalities, we aimed to increase access to dietitian services for patients with GI cancers to 25% from 5% over 12 months. We began by building a multidisciplinary QI team, which consisted of registered dietitians, registered nurses, and physicians. A workflow map and root cause analysis of the existing nutrition care was performed. We then used several Plan-Do-Study-Act (PDSA) cycles to implement the changes identified in our analysis. These included hiring a full-time outpatient oncology registered dietitian, incorporating a validated malnutrition screening tool (MST) into the electronic medical record (EMR), and conducting multidisciplinary meetings with all clinic staff, physicians, and administrators to demonstrate the use of the EMR based MST and the importance of identifying patients with malnutrition. To understand the degree of impact of the interventions on clinical parameters, we conducted chart review on all new dietitian outpatient visits for 3 months and showed stability of weight and performance status for the assessed patients. Although the overall impact was modest in nature, at its peak 21.8% of patients in a month were seen by a clinical dietitian, our systematic use of QI principles provides meaningful information for all oncology providers. Our data show the power of a universal screening tool to be used at every provider visit. This presentation will discuss the challenges we faced during implementation of this QI project in a clinical setting.
About Dr. Kazmi
Dr. Syed Kazmi is an Assistant Professor in the Department of Internal Medicine, Division of Hematology and Oncology at UT Southwestern Medical Center since 2017. He received his medical degree from the Aga Khan University in Karachi, Pakistan. He then obtained a Master of Research degree from the University of Glasgow, UK. He completed his internal medicine residency training at the UT Health Science Center at Houston, followed by Hematology and Oncology clinical fellowship training at MD Anderson Cancer Center in Houston. Since joining UT Southwestern Medical Center, he specializes in the management of gastrointestinal malignancies and develops clinical trials and translational research projects in colorectal cancers. Dr. Kazmi is co-leader of the gastrointestinal cancer disease-oriented team and the Phase 1 clinical trials team at the Harold C. Simmons Comprehensive Cancer Center in Dallas. He oversees clinical trials management in malignancies of the gastrointestinal tract and other solid tumors. Being a clinician, Dr. Kazmi is interested in developing quality improvement projects with teams focused on clinically relevant problems, especially in resource-poor settings.
Dr. Kazmi did not disclose any conflicts of interest for this workshop.