Symptom control in underserved Chinese American cancer patients: a community-based quality improvement intervention

Chinese Americans have high cancer rates and many are recent immigrants who are medically underserved. Patients have an elevated risk for poorly controlled pain. While quality improvement (QI) methodologies may improve practice and patient-reported outcomes, few QI programs exist for this population. The aims are to: (1) test the effectiveness of a rapid-cycle QI intervention to enhance the processes and outcomes of pain management for poor and underserved ethnic Chinese cancer patients; (2) determine whether a rapid-cycle QI intervention for pain can be generalized to other symptoms (fatigue; dyspnea); and (3) identify demographic, cultural, psychological, and other barriers and facilitators that are related to intervention uptake. In this ongoing community study, we are developing and testing a rapid-cycle QI model to improve pain among Chinese American cancer patients, and evaluating factors that influence its uptake and sustainability. Ethnic Chinese cancer patients and clinicians from four large community oncology practices are the intervention targets. The systems-based intervention, which applies rapid-cycle QI methods in collaboration with the oncology practices, includes: pain screening, follow-up for early identification and treatment of pain, referral, and clinician education. Post-implementation, a review of pain screening forms demonstrated that 23% of 650 patients screened over 150 days had moderate or severe pain. Of those with moderate pain, 42% received follow-up appointments within 1 week and 98% with severe pain had immediate clinician attention. Intervention effectiveness will be determined by 2-week longitudinal surveys. The primary outcome is the change over time in the proportion of patients who achieve adequate and timely pain control after initial presentation. These data demonstrate that a community-based QI program for cancer pain can be implemented in Chinese Americans. Future results may show the importance of community-based QI interventions in reducing pain disparities among underserved populations and producing long-term changes in clinical pain management.