Testing an enhanced community team model to improve access and quality of palliative and end of life care provided at home.

What is the problem?

Although most people would prefer to die at home, over 50% of people die in hospital. While the Hunter New England Local Health District is serviced by an integrated network of palliative care services, there is a lack of access to home-based care. Limited access is also greater in vulnerable populations, such as geographically isolated communities, younger patients, patients not eligible for aged care packages, and those with substantial delays accessing community aged care packages. Lack of support during periods of increased need results in patient and carer distress. It can also lead to preventable hospital admissions and impedes end of life care at home.

About the research translation program

Research shows that home palliative care services can significantly increase the number of deaths at home. Home services were also found to reduce symptom burden. The current project will pilot an enhanced palliative care community team model that integrates a small but agile pool of nursing resources (Assistants in Nursing and CNS Care Coordinator) to rapidly respond to the increased care needs of patients in the community who would prefer to stay at home. The model will involve a care co-ordinator undertaking a comprehensive, individualised and needs-based assessment for each patient to determine their care needs. Existing resources, such as a patient’s general practitioner, allied health professionals and nurse practitioners, as well as state and federal community service programs, will be used.

The pilot will involve the randomisation of participating sectors to either access the pool of enhanced nursing support or to continue current models of care. The primary outcome will be the number of days during follow-up (from time of referral to time of death) spent at home or death at location of choice. An economic (cost consequence) analysis will be performed to examine whether the cost of the model of care is outweighed by its effect on quality of life; patient and carer experience; time spent at location of choice; hospital or hospice admissions; and length of stay. The inclusion of two rural sectors will also allow researchers to determine what differences in service delivery need to be made to the enhanced palliative care community team model to account for the larger distances and lower density of patients found in rural and regional centres.

What will be the impact?

The project will directly benefit those patients recruited with provision of palliative care services at home, potentially reducing distress, preventing hospital admission and enabling patients to die at home if preferred. Assuming the model provides evidence of a positive effect and is cost-effective, the model of care may be expanded to other patient populations in the future.

For more information, contact Jessica Scaife at Jessica.Scaife@calvarymater.org.au