COMPANION: development of a patient-centred complexity and casemix classification for adult palliative care patients based on needs and resource use – a protocol for a cross-sectional multi-centre study

Abstract

Background A casemix classification based on patients’ needs can serve to better describe the patient group in palliative care and thus help to develop adequate future care structures and enable national benchmarking and quality control. However, in Germany, there is no such an evidence-based system to differentiate the complexity of patients’ needs in palliative care. Therefore, the study aims to develop a patient-oriented, nationally applicable complexity and casemix classification for adult palliative care patients in Germany. Methods COMPANION is a mixed-methods study with data derived from three subprojects. Subproject 1: Prospective, cross-sectional multi-centre study collecting data on patients’ needs which reflect the complexity of the respective patient situation, as well as data on resources that are required to meet these needs in specialist palliative care units, palliative care advisory teams, and specialist palliative home care. Subproject 2: Qualitative study including the development of a literature-based preliminary list of characteristics, expert interviews, and a focus group to develop a taxonomy for specialist palliative care models. Subproject 3: Multi-centre costing study based on resource data from subproject 1 and data of study centres. Data and results from the three subprojects will inform each other and form the basis for the development of the casemix classification. Ultimately, the casemix classification will be developed by applying Classification and Regression Tree (CART) analyses using patient and complexity data from subproject 1 and patient-related cost data from subproject 3. Discussion This is the first multi-centre costing study that integrates the structure and process characteristics of different palliative care settings in Germany with individual patient care. The mixed methods design and variety of included data allow for the development of a casemix classification that reflect on the complexity of the research subject. The consecutive inclusion of all patients cared for in participating study centres within the time of data collection allows for a comprehensive description of palliative care patients and their needs. A limiting factor is that data will be collected at least partly during the COVID-19 pandemic and potential impact of the pandemic on health care and the research topic cannot be excluded. Trial registration German Register for Clinical Studies trial registration number: DRKS00020517.

More than the sum of its parts—A constructivist grounded-theory study on specialist palliative care during crises like the COVID pandemic

“…Dataset (a) originated from expert interviews nested in the national research project COMPANION. 11 , 12 These interviews primarily focused on structure and process characteristics for a typology of specialist palliative care, which has been analyzed and reported elsewhere. 12 Due to the outbreak of COVID-19 shortly before data collection with a non-negligible impact on health care, we complemented the interview guide.…”

Using normalization process theory to evaluate the use of patient-centred outcome measures in specialist palliative home care—a qualitative interview study

“…The COMPANION project collected data (between 01/2021 and 09/2022) on patients’ complexity documented electronically by healthcare professionals, if possible integrated in the existing electronic patient record (four teams integrated, two teams not integrated), over a three-month time period using several PCOMs (Additional file 2 ) [ 17 ]. Six SPHC teams participated in the COMPANION study, located in five different federal states across Germany.…”

“…In Germany, the nationwide research project COMPANION (development of a patient-centred complexity and casemix classification for adult palliative care patients based on needs and resource use) used PCOMs in three specialist palliative care settings (palliative care unit, hospital advisory team and specialist palliative home care (SPHC)). The aim of the COMPANION project was to develop a German complexity and casemix classification for palliative care patients based on needs and resource use [ 17 ]. Its application will require the continuous and comprehensive use of PCOMs by healthcare professionals.…”