Persistent inequalities in Hospice at Home provision

Buck, Jackie; Webb, Liz; Moth, Lorraine; Morgan, Lynn Kasner; Barclay, Stephen

doi:10.1136/bmjspcare-2017-001367

Cited by 39 publications

(36 citation statements)

References 46 publications

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“…A possible reason for this might be that in an area with a higher number of hospices, the home-based hospice care might be better developed than in other areas. 61 Cancer patients were more likely to use hospice care at home or were facilitated to die at home, resulting in a higher chance of home death. In previous studies, the care home bed provision was found to be associated with care home death.…”

Section: Main Findingsmentioning

confidence: 99%

The role of service factors on variations in place of death: an observational study

Gao

Chukwusa

Verne

et al. 2019

Health Serv Deliv Res

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Background Previous studies have revealed that there is significant geographical variation in place of death in (PoD) England, with sociodemographic and clinical characteristics explaining ≤ 25% of this variation. Service factors, mostly modifiable, may account for some of the unexplained variation, but their role had never been evaluated systematically. Methods A national population-based observational study in England, using National Death Registration Database (2014) linked to area-level service data from public domains, categorised by commissioning, type and capacity, location and workforce of the services, and the service use. The relationship between the service variables and PoD was evaluated using beta regression at the area level and using generalised linear mixed models at the patient level. The relative contribution of service factors at the area level was assessed using the per cent of variance explained, measured by R2. The total impact of service factors was evaluated by the area under the receiver operating characteristic curve (AUC). The independent effect of service variables was measured at the individual level by odds ratios (ORs). Results Among the 431,735 adult deaths, hospitals were the most common PoD (47.3%), followed by care homes (23.1%), homes (22.5%) and hospices (6.1%). One-third (30.3%) of the deaths were due to cancer and two-thirds (69.7%) were due to non-cancer causes. Almost all service categories studied were associated with some of the area-level variation in PoD. Service type and capacity had the strongest link among all service categories, explaining 14.2–73.8% of the variation; service location explained 10.8–34.1% of the variation. The contribution of other service categories to PoD was inconsistent. At the individual level, service variables appeared to be more useful in predicting death in hospice than in hospital or care home, with most AUCs in the fair performance range (0.603–0.691). The independent effect of service variables on PoD was small overall, but consistent. Distance to the nearest care facility was negatively associated with death in that facility. At the Clinical Commissioning Group level, the number of hospices per 10,000 adults was associated with a higher chance of hospice death in non-cancer causes (OR 30.88, 99% confidence interval 3.46 to 275.44), but a lower chance of hospice death in cancer causes. There was evidence for an interaction effect between the service variables and sociodemographic variables on PoD. Limitations This study was limited by data availability, particularly those specific to palliative and end-of-life care; therefore, the findings should be interpreted with caution. Data limitations were partly due to the lack of attention and investment in this area. Conclusion A link was found between service factors and PoD. Hospice capacity was associated with hospice death in non-cancer cases. Distance to the nearest care facility was negatively correlated with the probability of a patient dying there. Effect size of the service factors was overall small, but the interactive effect between service factors and sociodemographic variables suggests that high-quality end-of-life care needs to be built on service-level configuration tailored to individuals’ circumstances. Future work A large data gap was identified and data collection is required nationally on services relevant to palliative and end-of-life care. Future research is needed to verify the identified links between service factors and PoD. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Section: Main Findingsmentioning

confidence: 99%

The role of service factors on variations in place of death: an observational study

Gao

Chukwusa

Verne

et al. 2019

Health Serv Deliv Res

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“…33,34 Some hospice at home services had low referral rates from deprived areas, and non-cancer patients. 36,38,42,43 Awareness raising activity was still required in other hospice at home services with carers, patients, families and healthcare professionals based in hospital settings. 8,10,25,44,45 There was evidence that healthcare professionals were actively referring into the hospice at home service.…”

Section: "Marketing and Referral"mentioning

confidence: 99%

“…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. 10 Although one service was resourced adequately, there was a common perception that the hospice at home service was unable to meet demand.…”

Section: "Sustainable Funding Model"mentioning

confidence: 99%

“…45 Having a dedicated telephone line resulted in high carer satisfaction and supported the work of the hospice at home service. 27,49 In terms of monitoring the hospice at home's responsiveness and availability, it was noted that not all patients received care in their preferred choice due the high demand, 10,36 in one instance the rapid response service did not impact on the patient's documented preferred place of death, 20 with a recognition that the hospice at home service needed to consider the complexities of providing 'individualised support' to deal with the changing journeys of carers and patients when dying. 9 "Criteria for Service Admission"…”

Section: "Sustainable Funding Model"mentioning

confidence: 99%

“…25 GPs were important in enabling access to the service, if they deemed that a patient could be cared for at home, 39 and if a family required psychological support and needed practical help for symptom control. 35,36 Referrals were also being appropriately triaged by the senior nurse at the hospice at home service using a RAG rating on the severity of clinical need of the patient and family. In terms of monitoring the criteria for service admission, the main tool used for reporting was whether patients died in their preferred place.…”

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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Socio-economic Position and Access to Specialist Palliative Care: Evidence from the UK

French

2022

Ethical Challenges for Healthcare Practices at the End of Life: Interdisciplinary Perspectives

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Persistent inequalities in Hospice at Home provision

Abstract: Objective To describe the nature and scope of a new Hospice at Home (H@H) service and to identify its equality of provision. Methods Case note review of patients supported by a H@H service for 1 year from

Cited by 39 publications

References 46 publications

The role of service factors on variations in place of death: an observational study

The role of service factors on variations in place of death: an observational study

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

Socio-economic Position and Access to Specialist Palliative Care: Evidence from the UK

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