Avoiding costly hospitalisation at end of life: findings from a specialist palliative care pilot in residential care for older adults.

Chapman, M; Johnston, N; Lovell, C; Forbat, L; Liu, W-M

Avoiding costly hospitalisation at end of life: findings from a specialist palliative care pilot in residential care for older adults.

Chapman, M

Johnston, N Lovell, C Forbat, L Liu, W-M

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Publisher:: BMJ PUBLISHING GROUP
Publication Type:: Journal Article
Citation:: BMJ Support Palliat Care, 2018, 8, (1), pp. 102-109
Issue Date:: 2018-03

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Field	Value	Language
dc.contributor.author	Chapman, M https://orcid.org/0000-0003-1333-3448
dc.contributor.author	Johnston, N
dc.contributor.author	Lovell, C
dc.contributor.author	Forbat, L
dc.contributor.author	Liu, W-M
dc.date.accessioned	2022-09-11T01:56:45Z
dc.date.available	2016-07-14
dc.date.available	2022-09-11T01:56:45Z
dc.date.issued	2018-03
dc.identifier.citation	BMJ Support Palliat Care, 2018, 8, (1), pp. 102-109
dc.identifier.issn	2045-435X
dc.identifier.issn	2045-4368
dc.identifier.uri	http://hdl.handle.net/10453/161649
dc.description.abstract	OBJECTIVES: Specialist palliative care is not a standardised component of service delivery in nursing home care in Australia. Specialist palliative care services can increase rates of advance care planning, decrease hospital admissions and improve symptom management in such facilities. New approaches are required to support nursing home residents in avoiding unnecessary hospitalisation and improving rates of dying in documented preferred place of death. This study examined whether the addition of a proactive model of specialist palliative care reduced resident transfer to the acute care setting, and achieved a reduction in hospital deaths. METHODS: A quasi-experimental design was adopted, with participants at 4 residential care facilities. The intervention involved a palliative care nurse practitioner leading 'Palliative Care Needs Rounds' to support clinical decision-making, education and training. Participants were matched with historical decedents using propensity scores based on age, sex, primary diagnosis, comorbidities and the Aged Care Funding Instrument rating. Outcome measures included participants' hospitalisation in the past 3 months of life and the location of death. RESULTS: The data demonstrate that the intervention is associated with a substantial reduction in the length of hospital stays and a lower incidence of death in the acute care setting. While rates of hospitalisation were unchanged on average, length of admission was reduced by an average of 3.22 days (p<0.01 and 95% CI -5.05 to -1.41), a 67% decrease in admitted days. CONCLUSIONS: The findings have significant implications for promoting quality outcomes through models of palliative care service delivery in residential facilities.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	BMJ PUBLISHING GROUP
dc.relation.ispartof	BMJ Support Palliat Care
dc.relation.isbasedon	10.1136/bmjspcare-2015-001071
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1110 Nursing, 1117 Public Health and Health Services
dc.subject.mesh	Aged, 80 and over
dc.subject.mesh	Female
dc.subject.mesh	Homes for the Aged
dc.subject.mesh	Hospitalization
dc.subject.mesh	Humans
dc.subject.mesh	Length of Stay
dc.subject.mesh	Male
dc.subject.mesh	Nursing Homes
dc.subject.mesh	Palliative Care
dc.subject.mesh	Pilot Projects
dc.subject.mesh	Specialization
dc.subject.mesh	Terminal Care
dc.subject.mesh	Humans
dc.subject.mesh	Hospitalization
dc.subject.mesh	Length of Stay
dc.subject.mesh	Palliative Care
dc.subject.mesh	Terminal Care
dc.subject.mesh	Pilot Projects
dc.subject.mesh	Aged, 80 and over
dc.subject.mesh	Homes for the Aged
dc.subject.mesh	Nursing Homes
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Specialization
dc.title	Avoiding costly hospitalisation at end of life: findings from a specialist palliative care pilot in residential care for older adults.
dc.type	Journal Article
utslib.citation.volume	8
utslib.location.activity	England
utslib.for	1110 Nursing
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access	*
dc.date.updated	2022-09-11T01:56:44Z
pubs.issue	1
pubs.publication-status	Published
pubs.volume	8
utslib.citation.issue	1

Abstract:

OBJECTIVES: Specialist palliative care is not a standardised component of service delivery in nursing home care in Australia. Specialist palliative care services can increase rates of advance care planning, decrease hospital admissions and improve symptom management in such facilities. New approaches are required to support nursing home residents in avoiding unnecessary hospitalisation and improving rates of dying in documented preferred place of death. This study examined whether the addition of a proactive model of specialist palliative care reduced resident transfer to the acute care setting, and achieved a reduction in hospital deaths. METHODS: A quasi-experimental design was adopted, with participants at 4 residential care facilities. The intervention involved a palliative care nurse practitioner leading 'Palliative Care Needs Rounds' to support clinical decision-making, education and training. Participants were matched with historical decedents using propensity scores based on age, sex, primary diagnosis, comorbidities and the Aged Care Funding Instrument rating. Outcome measures included participants' hospitalisation in the past 3 months of life and the location of death. RESULTS: The data demonstrate that the intervention is associated with a substantial reduction in the length of hospital stays and a lower incidence of death in the acute care setting. While rates of hospitalisation were unchanged on average, length of admission was reduced by an average of 3.22 days (p<0.01 and 95% CI -5.05 to -1.41), a 67% decrease in admitted days. CONCLUSIONS: The findings have significant implications for promoting quality outcomes through models of palliative care service delivery in residential facilities.

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http://hdl.handle.net/10453/161649