BackgroundMore people die in hospital than in any other setting which is why it is important to study the outcomes of hospital care at end of life. This study analyses what influenced outcomes in a sample of patients who died in hospital in Ireland in 2008/9. The study was undertaken as part of the Irish Hospice Foundation’s Hospice Friendly Hospitals Programme (2007–2012).MethodsOutcomes of care were assessed by nurses, doctors and relatives who cared for the patient during the last week of life. Multi-level modelling was used to analyse how care outcomes were influenced by care inputs.ResultsThe sample of 999 patients represents 10% of acute hospital deaths and 29% of community hospital deaths in Ireland in 2008/9. Five care outcomes were assessed for each patient: symptom experience, symptom management, patient care, acceptability of the way patient died, family support. Care outcomes during the last week of life tended to be better when: the patient had cancer; admission to hospital was planned rather than emergency; death occurred in a single room or where privacy, dignity and environment of the ward was better; team meetings were held; there was good communication with patients and relatives; relatives were facilitated to stay overnight and were present at the time of death; nursing staff were experienced and had training in end-of-life care; the hospital had specific objectives for developing end-of-life care in its service plan.ConclusionsThe study shows significant differences in how care outcomes, including pain, were assessed by nurses, doctors and relatives. Care inputs operate in a mutually reinforcing manner to generate care outcomes which implies that improvements in one area are likely to have spill-over effects in others. Building on these findings, the Irish Hospice Foundation has developed an audit and review system to support quality improvement in all care settings where people die.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-015-0014-2) contains supplementary material, which is available to authorized users.

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The study analyses determinants of child outcomes in a cohort of children who participated in the Free Pre-School Year. Child outcomes are measured through a before-and-after assessment of children using the Early Development Instrument. The sample comprises 448 children in 70 early years centres. There are three main findings. First, children with more or better skills at the beginning of the study period tended to have more or better skills at the end of this period, and vice versa, indicating that the broad parameters of a child's progress during the Free Pre-School Year have already been set by the child's development during previous years. Second, child and family characteristics are the largest set of measured influences on child outcomes by comparison with the pre-school system, with social class being the single biggest influence. Third, there were significant skill gaps between children at the start of the Free Pre-School Year which remained unchanged or widened during the year. The main conclusion is that the measures required to improve child outcomes in pre-school need to extend well beyond the confines of the early years sector to include all influences, especially family and social class influences, on child development and need to begin at the start of the child's life.

The article reports the results from an evaluation of Springboard, a family support programme introduced in Ireland during 1998. The evaluation is based on a non-experimental design involving a pre-post comparison of 319 children and 191 parents who participated in the programme. The two main outcomes reported here are children's psychological well-being (measured by the Strengths and Difficulties Questionnaire -SDQ), and the parent-child relationship (measured by the Parent-Child Relationship Inventory -PCRI). Results showed improvements in SDQ and PCRI scores, equivalent to an effect size in the range 0.2 to 0.3, which is similar to the effect sizes produced by other family support programmes. At the end of the intervention, there was still a substantial amount of unmet need among children. The evaluation has two limitations: first, the use of a nonexperimental method means that we cannot be certain that all of the improved outcomes can be attributed to Springboard; second, the diverse interventions which constitute Springboard, and family support programmes generally, means that it is impossible to separate effective from ineffective interventions within the programme. Policy and Practice Implications The underlying patterns of thought and behaviour which create problems for children and parents are highly stable and there is no 'quick-fix' solution.  Family difficulties have an inter-generational dimension because parents who have experienced abuse as children tend to have impaired parenting capacity which, in turn, may create difficulties for their own children.  There are significant variations in the perceptions of parents and professionals as to what is 'normal' for children, illustrating the complexities of intervening in families.  In this evaluation, maternal employment created a trade-off between the well-being of mothers and the well-being of their children because mothers' employment reduced their financial difficulties but also increased the difficulties for children and reduced parenting capacity. This suggests that arrangements for the care and protection of children when mothers are out at work cannot be taken for granted and the child's experience of their mother's employment should be taken into account.  Springboard experienced difficulties engaging Traveller families and this suggests that staff may need to gain a better understanding of Traveller culture and how to support Traveller families.

PurposeThe purpose of this paper is to analyse the processes and outcomes of a five‐year initiative to develop inter‐agency working between services for vulnerable 10‐ to 18‐year‐olds in a disadvantaged area of Dublin, Ireland.Design/methodology/approachA case study methodology included: review of documentation on 32 formal meetings of the network; 43 interviews with agency personnel involved in the network; in‐depth review of nine randomly selected cases which had been treated according to the network's agreed protocol of inter‐agency case management.FindingsThe initiative created a vibrant inter‐agency process in terms of developing and implementing an agreed protocol for inter‐agency care planning. However, assessment of the outcomes for young people and their families showed that only a few made any improvement. Four reasons are suggested for this relatively modest result: the target group of 10‐ to 18‐year‐olds had experienced neglect and abuse over many years and this made it difficult to achieve positive outcomes for them; the quality and standard of work by some staff in some agencies was questionable; agencies did not seem to include inter‐agency work in assessing their overall performance, or the performance of individual staff; and most agencies did not seem to have adopted an outcome‐oriented, evidence‐based approach to their work.Originality/valueThe paper points out that an effective and inclusive inter‐agency process is necessary but not enough for improving child outcomes; the sufficient condition for improved child outcomes is effective intra‐agency processes to deliver high‐quality services and a policy environment that supports and requires it.