Impact of a hospice rapid response service on preferred place of death, and costs

Gage, Heather; Holdsworth, Laura M.; Flannery, Caragh; Williams, Peter; Butler, Claire

doi:10.1186/s12904-015-0065-4

Cited by 20 publications

(39 citation statements)

References 27 publications

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“…Existing evidence suggests that provision of a rapid response service increases the chances of patients dying at home if that is their preference as does increased public awareness of the HAH services. [17][18][19] The final NAHH standard promotes systems and processes to ensure pre/post-bereavement support for patients (where appropriate), carers and families. Views on enablers from respondents to the survey identified that services benefited from a well-trained and extensive network of third sector support, volunteers and family support.…”

Section: Discussionmentioning

confidence: 99%

Hospice at Home services in England: a national survey

Rees-Roberts

Williams

Hashem

et al. 2019

BMJ Support Palliat Care

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ObjectiveHospice at Home (HAH) services aim to enable patients to be cared for and die at home, if that is their choice and achieve a ‘good death’. A national survey, in 2017, aimed to describe and compare the features of HAH services and understand key enablers to service provision.MethodsService managers of adult HAH services in the ‘Hospice UK’ and National Association for Hospice at Home directories within England were invited to participate. Information on service configuration, referral, staffing, finance, care provision and enablers to service provision were collected by telephone interview.ResultsOf 128 services invited, 70 (54.7%) provided data. Great diversity was found. Most services operated in mixed urban/rural (74.3%) and mixed deprivation (77.1%) areas and provided hands-on care (97.1%), symptom assessment and management (91.4%), psychosocial support (94.3%) and respite care (74.3%). Rapid response (within 4 hours) was available in 65.7%; hands-on care 24 hours a day in 52.2%. Charity donations were the main source of funding for 71.2%. Key enablers for service provision included working with local services (eg, district nursing, general practitioner services), integrated health records, funding and anticipatory care planning. Access to timely medication and equipment was critical.ConclusionThere is considerable variation in HAH services in England. Due to this variation it was not possible to categorise services into delivery types. Services work to supplement local care using a flexible approach benefitting from integration and funding. Further work defining service features related to patient and/or carer outcomes would support future service development.

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Section: Discussionmentioning

confidence: 99%

Hospice at Home services in England: a national survey

Rees-Roberts

Williams

Hashem

et al. 2019

BMJ Support Palliat Care

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“…26,27,38 Although direct evidence on the monitoring of marketing and referral strategies of hospice at home services was far from explicit, it was recommended by Gage et al that commissioners would benefit from knowing about service under-utilisation. 48 In addition, Wilson et al noted that carers required more awareness raising about the availability of bereavement support. 49…”

Section: "Marketing and Referral"mentioning

confidence: 99%

“…Gage et al suggests that having an integrated co-ordinating service between providers did not impact upon whole systems costs. 48 "Service Responsiveness and Availability"…”

Section: "Sustainable Funding Model"mentioning

confidence: 99%

“…If patients and carers had regular contact with a hospice at home service that had adequate rapid response capacity, 23,24 the evidence showed that patients and carers would continue with the hospice at home service, 9,51 as increased availability would be responsive to patient choice, would adapt to changes in preferences supported by adequate staff resources, and underpinned by access to equipment to meet demand. 37,44,45,47,48 The availability of a co-ordinating centre for identifying access to care packages and equipment was important for providing fast and efficient care, 25,27,33,34 and having access to palliative medicine and specialist nursing staff for symptom management and psychosocial support. 26,36,37,[39][40][41]44 The problems with access to medications and issues around organising visits from trained staff were reported as common barriers encountered, 10,47,49,[51][52][53] with rural areas reporting particular problems with access to trained staff.…”

Section: "Sustainable Funding Model"mentioning

confidence: 99%

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Understanding what works, why and in what circumstances in hospice at home services for end-of-life care: Applying a realist logic of analysis to a systematically searched literature review

et al. 2019

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Background: We have undertaken a systematically searched literature review using a realist logic of analysis to help synthesise the diverse range of literature available on hospice at home services. Aim: To find out in the existing literature what features of hospice at home models work best, for whom and under what circumstances. Design: A realist logic of analysis was applied to synthesise the evidence focusing on mechanisms by which an intervention worked (or did not work). An initial programme theory was developed using the National Association for Hospice at Home standards, Normalisation Process Theory and through refinement using stakeholder engagement. Data sources: PubMed, Science Direct, AMED, BNI, CINAHL, EMBASE, Health Business Elite, HMIC, Medline, PsychINFO, SCOPUS, Web of Science, DARE, Google Scholar, NHS Evidence, NIHR CRN portfolio database, NIHR journal library of funded studies, including searches on websites of relevant professional bodies (August 2014, June 2017, June 2019). Results: Forty-nine papers were reviewed, of which 34 contributed evidence to at least one of the eight theory areas: marketing and referral, sustainable funding model, service responsiveness and availability, criteria for service admission, knowledge and skills of care providers, integration and coordination, anticipatory care, support directed at carers. Conclusions: Our literature review showed how it was possible to develop a coherent framework and test it against 34 published papers and abstracts. Central to this review was theory building, and as further evidence emerges, our programme theories can be refined and tested against any new empirical evidence.

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“…Physician support, palliative care involvement, and family support improve congruence [ 8 10 ]. The use of 24/7 services increased the chance of dying at a preferred place by 2.1 times [ 11 ]. The services of home-based end-of-life care, as part of palliative care programs, increased the probability of care and dying at home [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

The Hospice Information System and its association with the congruence between the preferred and actual place of death

et al. 2017

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Objective:A Hospice Information System (HIS) developed in eastern Taiwan in 2012 aimed to improve the quality of hospice care through an integrated system that provided telemetry-based vital sign records, online 24/7 consultations, online video interviews, and online health educations. The purpose of this study was to explore the congruence between the preferred and actual place of death (POD) among patients who received HIS services.Materials and Methods:A retrospective study was performed from January 2012 to August 2016. Data from patients enrolled in the HIS who died during this period were included. Data on basic characteristics and the actual and preferred POD were obtained from the HIS database. The primary outcome was the congruence between the preferred and actual POD. Secondary outcomes were comparisons between patients who did and did not achieve their preferred POD. Further comparisons between patients who did and did not achieve home death were also performed.Results:In total, we enrolled 481 patients who received HIS services and died. Of them, 444 (92.3%) died at their preferred POD. Patients who preferred an inpatient hospice as their POD had higher achievement rate than those who wanted a home death. High-intensity HIS utilization was associated with a higher likelihood of home death than low-intensity HIS utilization. Patients living in areas distant from the medical center had lower achievement of home death than those living in local areas.Conclusions:This study suggested that patients enrolled in the HIS had high congruence between the actual and preferred POD.

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Impact of a hospice rapid response service on preferred place of death, and costs

Cited by 20 publications

References 27 publications

Hospice at Home services in England: a national survey

Hospice at Home services in England: a national survey

Understanding what works, why and in what circumstances in hospice at home services for end-of-life care: Applying a realist logic of analysis to a systematically searched literature review

The Hospice Information System and its association with the congruence between the preferred and actual place of death

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