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Medical Science OPEN ACCESS

Use of QAPI Methodology for Risk Management in Home Palliative Care

Tatevik Melkumyan
MD Endocrinologist, Radiologist, Armenia, Owner NT QA INC, Qa consultant for home health and hospices, USA Los Angeles, California, USA
DOI Crossref DOI 10.37547/tajmspr/Volume07Issue07-02
tajmspr 2025
VOL. 7 / NO. 07 JULY
FULL TEXT PP. 7-14
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VOLUME 7
ISSUE 07
YEAR 2025
PAGES 7-14
RESEARCH OVERVIEW

Abstract

This article presents a theoretical and analytical review of the applicability of the QAPI (Quality Assurance and Performance Improvement) methodology for risk management in home-based palliative care. The study is based on an interdisciplinary approach that integrates systems theory, the Donabedian model, quality of care assessment tools, and digital monitoring algorithms. Particular attention is given to aligning structure, process, and outcome indicators with empirical data on patient needs and organizational barriers specific to outpatient settings. Sources covering patient-centered care, resource constraints, multicultural contexts, and care digitalization are analyzed. Based on regression models and content analysis of the literature, key risks are identified, including emotional burnout, informational deficits, inadequate symptom control, and insufficient spiritual support. A conceptual model for QAPI integration is proposed, which incorporates both technical and humanitarian aspects of quality. The developed framework includes indicators adapted to the context of home care, digital visualization tools, and principles for sustainable implementation under resource constraints. This article will be of interest to researchers in palliative medicine, quality management professionals, outpatient care coordinators, and all those involved in developing and implementing patient-centered systems for evaluating and improving home-based care.

RESEARCH TOPICS

Keywords

QAPI palliative care home care risk management

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References

  1. Alizadeh, Z., Rohani, C., Rassouli, M., Ilkhani, M., & Hazrati, M. (2024). Bridging the gap and developing a home-based palliative care model for cancer patients. Asia-Pacific Journal of Oncology Nursing, 11(11), 100583. https://doi.org/10.1016/j.apjon.2024.100583
  2. Anghel, I., Cioara, T., Bevilacqua, R., Barbarossa, F., Grimstad, T., Hellman, R., Solberg, A., Boye, L. T., Anchidin, O., Nemes, A., & Gabrielsen, C. (2025). New care pathways for supporting transitional care from hospitals to home using AI and personalized digital assistance. arXiv. https://doi.org/10.48550/arXiv.2504.13877
  3. Carpenter, J. G., Lam, K., Ritter, A. Z., & Ersek, M. (2020). A systematic review of nursing home palliative care interventions: Characteristics and outcomes. Journal of the American Medical Directors Association, 21(5), 583–596.e2. https://doi.org/10.1016/j.jamda.2019.11.015
  4. Elshehaly, M., Randell, R., Brehmer, M., McVey, L., Alvarado, N., Gale, C. P., & Ruddle, R. A. (2020). QualDash: Adaptable generation of visualisation dashboards for healthcare quality improvement. arXiv. https://doi.org/10.48550/arXiv.2009.03002
  5. Haneuse, S., Schrag, D., Dominici, F., Normand, S.-L., & Lee, K. H. (2021). Measuring performance for end-of-life care. arXiv. https://doi.org/10.48550/arXiv.2105.08776
  6. Kan, Y., Xiao, Y., Li, Z., Chen, Z., & Yue, P. (2025). Quality indicators for home-based palliative care: A systematic review. Journal of Pain and Symptom Management. Advance online publication. https://doi.org/10.1016/j.jpainsymman.2025.06.011
  7. Liu, X., Liu, H., Ying, W., Zhang, Y., Gong, X., & Huang, J. (2025). Identifying palliative home care needs of patients with advanced cancer: A cross-sectional study. Frontiers in Psychiatry, 16. https://doi.org/10.3389/fpsyt.2025.1448973
  8. Quigley, D. D., & McCleskey, S. G. (2021). Improving care experiences for patients and caregivers at end of life: A systematic review. American Journal of Hospice and Palliative Medicine®, 38(1), 84–93. https://doi.org/10.1177/1049909120931468
  9. Shalom, E., Goldstein, A., Wais, R., Slivanova, M., Melamed Cohen, N., & Shahar, Y. (2024). Implementation and evaluation of a system for assessment of the quality of long-term management of patients at a geriatric hospital. Journal of Biomedical Informatics, 156, 104686. https://doi.org/10.1016/j.jbi.2024.104686
  10. Toles, M., Colón-Emeric, C., Moreton, E., Frey, L., & Leeman, J. (2021). Quality improvement studies in nursing homes: A scoping review. BMC Health Services Research, 21(1), 803. https://doi.org/10.1186/s12913-021-06803-8