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4. Who needs, receives and misses out on palliative and end-of-life care? A population-based study to identify needs and gaps in a regional health service.

Author

Westley-Wise, Victoria, Moules, Stephen, Masso, Malcolm, Barclay, Greg, Nangati, Zivai, Allingham, Sam, Davis, Joanne, and Eagar, Kathy

Subjects
RESEARCH, TERMINAL care, CONFIDENCE intervals, CROSS-sectional method, RESEARCH methodology, MULTIPLE regression analysis, DESCRIPTIVE statistics, SOCIODEMOGRAPHIC factors, ODDS ratio, DATA analysis software, PALLIATIVE treatment, MEDICAL needs assessment, EVALUATION
Abstract

Objective. The aim of this study was to assess the unmet need for palliative and other end-of-life care, as well as the sociodemographic and diagnostic factors associated with suboptimal access, among residents in an Australian region. Methods. A cross-sectional descriptive and analytical study was performed using non-identifiable linked data from four administrative and two clinical datasets. The study population comprised 3175 patients aged 15 years who died in hospital in 2016 and 2017. The main outcome measures were the proportion of decedents potentially benefitting from endof- life care and receiving end-of-life care. Results. An estimated 74.8% of decedents needed palliative or other end-of-life care in the year before death. Approximately 13.3% did not receive any end-of-life care despite its potential benefit. The highest proportions with 'unmet need' were decedents with chronic obstructive pulmonary disease (31.0%) and heart failure (26.3%). Adjusting for sociodemographic and diagnostic factors, access was lowest among those aged,65 years (adjusted odds ratio (aOR) 0.44; 95% confidence interval (CI) 0.31-0.64) and those with heart failure (aOR 0.58; 95% CI 0.47-0.72). Conclusions. Estimates of need and access provide a sound basis for planning local palliative and end-of-life care services. These methods can be used on an ongoing basis to monitor service delivery. [ABSTRACT FROM AUTHOR]

Published
2022
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8. The Australian Palliative Care Outcomes Collaboration (PCOC) - measuring the quality and outcomes of palliative care on a routine basis

Author

Eagar, Kathy, Watters, Prue, Currow, David, Aoun, Samar, Yates, Patsy, Eagar, Kathy, Watters, Prue, Currow, David, Aoun, Samar, and Yates, Patsy

Abstract

Australia is leading the way in establishing a national system (the Palliative Care Outcomes Collaboration – PCOC) to measure the outcomes and quality of specialist palliative care services and to benchmark services across the country. This article reports on analysis of data collected routinely at point-of-care on 5939 patients treated by the first fifty one services that voluntarily joined PCOC. By March 2009, 111 services have agreed to join PCOC, representing more than 70% of services and more than 80% of specialist palliative care patients nationally. All states and territories are involved in this unique process that has involved extensive consultation and infrastructure and close collaboration between health services and researchers. The challenges of dealing with wide variation in outcomes and practice and the progress achieved to date are described. PCOC is aiming to improve understanding of the reasons for variations in clinical outcomes between specialist palliative care patients and differences in service outcomes as a critical step in an ongoing process to improve both service quality and patient outcomes. What is known about the topic? Governments internationally are grappling with how best to provide care for people with life limiting illnesses and how best to measure the outcomes and quality of that care. There is little international evidence on how to measure the quality and outcomes of palliative care on a routine basis. What does this paper add? The Palliative Care Outcomes Collaboration (PCOC) is the first effort internationally to measure the outcomes and quality of specialist palliative care services and to benchmark services on a national basis through an independent third party. What are the implications for practitioners? If outcomes and quality are to be measured on a consistent national basis, standard clinical assessment tools that are used as part of everyday clinical practice are necessary.

Published
2010

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