Active identification of patients appropriate for palliative care: Impact on use of palliative care and home care resources.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 101-101
Author(s):  
Nicole Mittmann ◽  
Ning Liu ◽  
Marnie MacKinnon ◽  
Soo Jin Seung ◽  
Nicole Look Hong ◽  
...  
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Service Use ◽  
Intervention Group ◽  
Home Care Services ◽  
Control Group ◽  
Palliative Approach ◽  
Active Identification ◽  
Care Services ◽  
Primary Care Teams

101 Background: This research evaluates whether active identification of patients who may benefit from a palliative approach to care changes the use of palliative care and home care services. Methods: Between 2014 and 2017, Cancer Care Ontario implemented the INTEGRATE project at 4 cancer centres and 4 primary care teams. Physicians in participating sites were encouraged to systematically identify patients who were likely to die within 1 year and would benefit from a palliative approach to care. Patients in the INTEGRATE intervention group were 1:1 matched to non-intervention controls selected from provincial healthcare administrative data based on a publicly funded health system using the propensity score-matching. Palliative care and home care services utilization was evaluated within 1 year after the date of identification (index date), censoring on death, or March 31, 2017, the study end date. Cumulative incidence function was used to estimate the probability of having used care services, with death as a competing event. Rate of service use per 360 patient-days was calculated. Analyses were done separately for palliative care and home care. Results: Of the 1,187 patients in the INTEGRATE project, 1,185 were matched to a control. The intervention and the control groups were well-balanced on demographics, diagnosis, comorbidities, and death status. The probability of using palliative services in the intervention group was 80.3%, which was significantly higher than that in the control group (62.4%) with more palliative care visits in the intervention group [29.7 (95%CI: 29.4 to 30.1] per 360 patient-days) than in the control group [19.6 (95%CI: 19.3 to 19.9) per 360 patient-days]. The intervention group had a greater probability of receiving home care (81.4%) than the control group (55.2%) with more homecare visits per 360 patient-days [64.7 (95%CI: 64.2 to 65.3) vs. 35.3 (95%CI: 34.9 to 35.7)] The intervention group also had higher physician home visits as compared to the control group (36.5% vs. 23.7%). Conclusions: Physicians actively identifying patients that would benefit from palliative care resulted in increased use of palliative care and home care services.

scholarly journals Interprofessional Stroke Rehabilitation for Stroke Survivors Using Home Care

2011 ◽  
Vol 38 (2) ◽  
pp. 317-334 ◽  
Author(s):  
Maureen Markle-Reid ◽  
Camille Orridge ◽  
Robin Weir ◽  
Gina Browne ◽  
Amiram Gafni ◽  
...  
Keyword(s):  
Home Care ◽  
Stroke Rehabilitation ◽  
Intervention Group ◽  
Home Care Services ◽  
Stroke Survivors ◽  
Interprofessional Team ◽  
Care Services ◽  
Sf 36

Objective:To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services.Methods:Randomized controlled trial of 101 community-living stroke survivors (<18 months post-stroke) using home care services. Subjects were randomized to intervention (n=52) or control (n=49) groups. The intervention was a 12-month specialized, evidence-based rehabilitation strategy involving an interprofessional team. The primary outcome was change in health-related quality of life and functioning (SF-36) from baseline to 12 months. Secondary outcomes were number of strokes during the 12-month follow-up, and changes in community reintegration (RNLI), perceived social support (PRQ85-Part 2), anxiety and depressive symptoms (Kessler-10), cognitive function (SPMSQ), and costs of use of health services from baseline to 12 months.Results:A total of 82 subjects completed the 12-month follow-up. Compared with the usual care group, stroke survivors in the intervention group showed clinically important (although not statistically significant) greater improvements from baseline in mean SF-36 physical functioning score (5.87, 95% CI -3.98 to 15.7; p=0.24) and social functioning score (9.03, CI-7.50 to 25.6; p=0.28). The groups did not differ for any of the secondary effectiveness outcomes. There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant (p = 0.76).Conclusions:A 12-month specialized, interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care. Clinicaltrials.gov identifier: NCT00463229

scholarly journals Impacts of a Care Robotics Project on Finnish Home Care Workers’ Attitudes towards Robots

2020 ◽  
Vol 17 (19) ◽  
pp. 7176
Author(s):  
Teemu Rantanen ◽  
Teppo Leppälahti ◽  
Jaakko Porokuokka ◽  
Sari Heikkinen
Keyword(s):  
Home Care ◽  
Elderly Care ◽  
Test Group ◽  
Home Care Services ◽  
Two Dimensions ◽  
Control Group ◽  
Care Services ◽  
Care Robots ◽  
Care Workers ◽  
Home Care Workers

Technological advances in elderly care have been rapid, and the introduction of robots in care will be a topical issue in the near future. There has been little research into the possibility of influencing care workers’ attitudes towards robots by project activities, and how to make the change easier for work communities. This study focuses on a robotics project that took place in elderly and home care services in one municipality in Finland (total of 45 care workers). During the project, four robotics workshops and one extended pilot session were implemented. The study follows quasi-experimental settings, and it included two measurements (before and after project activities) and a control group, but no randomization. The data were collected by questionnaires and were analyzed statistically. The project under study brought about minor positive changes in home care workers’ attitudes towards the usefulness of care robots. In the final measurement, the difference between the test group and the control group was significant in the two dimensions of positive attitudes. The research supports the hypothesis that project activities can be used to influence home care workers’ attitudes towards robots. This can also facilitate the introduction of care robots in home care services. However, the construction of a technology-positive care culture is a long-term process, which requires training and development, technological development and strong strategic management at various levels.

scholarly journals Drivers of care costs and quality in the last 3 months of life among older people receiving palliative care: A multinational mortality follow-back survey across England, Ireland and the United States

2020 ◽  
Vol 34 (4) ◽  
pp. 513-523 ◽  
Author(s):  
Deokhee Yi ◽  
Bridget M Johnston ◽  
Karen Ryan ◽  
Barbara A Daveson ◽  
Diane E Meier ◽  
...  
Keyword(s):  
United States ◽  
Palliative Care ◽  
Home Care ◽  
Service Use ◽  
The United States ◽  
Care Services ◽  
Health And Social Care ◽  
Total Care ◽  
Palliative Care Services ◽  
Care Costs

Background: Care costs rise towards the end of life. International comparison of service use, costs and care experiences can inform quality and improve access. Aim: The aim of this study was to compare health and social care costs, quality and their drivers in the last 3 months of life for older adults across countries. Null hypothesis: no difference between countries. Design: Mortality follow-back survey. Costs were calculated from carers’ reported service use and unit costs. Setting: Palliative care services in England (London), Ireland (Dublin) and the United States (New York, San Francisco). Participants: Informal carers of decedents who had received palliative care participated in the study. Results: A total of 767 questionnaires were returned: 245 in England, 282 in Ireland and 240 in the United States. Mean care costs per person with cancer/non-cancer were US$37,250/US$37,376 (the United States), US$29,065/US$29,411 (Ireland), US$15,347/US$16,631 (England) and differed significantly ( F = 25.79/14.27, p < 0.000). Cost distributions differed and were most homogeneous in England. In all countries, hospital care accounted for > 80% of total care costs; community care 6%–16%, palliative care 1%–15%; 10% of decedents used ~30% of total care costs. Being a high-cost user was associated with older age (>80 years), facing financial difficulties and poor experiences of home care, but not with having cancer or multimorbidity. Palliative care services consistently had the highest satisfaction. Conclusion: Poverty and poor home care drove high costs, suggesting that improving community palliative care may improve care value, especially as palliative care expenditure was low. Major diagnostic variables were not cost drivers. Care costs in the United States were high and highly variable, suggesting that high-cost low-value care may be prevalent.

Simultaneous Care clinic (SCC): A three-year monoinstituional experience.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 169-169
Author(s):  
Silvia Stragliotto ◽  
Antonella Brunello ◽  
Sara Galuppo ◽  
Sabina Murgioni ◽  
Vincenzo Dadduzio ◽  
...  
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Median Time ◽  
Social Issues ◽  
Home Care Services ◽  
Cancer Type ◽  
Nutritional Evaluation ◽  
Care Clinic ◽  
Oncological Treatment ◽  
Care Services

169 Background: Early palliative care has been shown to improve outcomes in pts with advanced cancer. In accordance with ASCO and AIOM recommendations of implementing palliative care early for pts with metastatic cancer along with active cancer treatment a SCC was set up at Istituto Oncologico Veneto (IOV) in Padova since 2014; Methods: Data of pts referred to the SCC from Mar 2014 to Nov 2016 were retrieved from a prospectively maintained database. Data collected included cancer type, status of disease, PS, ongoing oncological treatment, psychological evaluation, social evaluation, nutritional evaluation, activation of home territorial services and/or Palliative Care services, use of other health services after a first visit and place of death; Results: 533 pts were evaluated by a multidisciplinary team. Overall symptom burden was low with baseline symptom scores highest for fatigue, lack of appetite and depression. Nutritional evaluation revealed 224 pts (42%) with nutritional problems, the most frequent being weight loss (n = 121). Psychological distress was present in 185 pts (35%). Social issues were present in 26 pts (5%) and were dealt with activation of social services (n = 9) or volunteer territorial services (n = 8). Patients deemed in need of home care services after the first access to the SCC were 177 (33%) and for these a formal request for Home Care services activation was sent to the Local Health Territorial Unit. After the first visit 141 patients referred to Emergency Room for intervening problems with median time of 41 days. Globally 290 pts (54%) died with 53% of deaths occurring at home. For pts who were receiving active oncological treatment median time from first-visit in the SCC and death was 126 days. We are also evaluating a score for priority for access to SCC; Conclusions: Early integrated SC may be most effective if targeted to the specific needs of each patient population

scholarly journals Self-management program versus usual care for community-dwelling older adults with multimorbidity: A pragmatic randomized controlled trial in Ontario, Canada

2020 ◽  
Vol 10 ◽  
pp. 2235042X2096339
Author(s):  
Kathryn Fisher ◽  
Maureen Markle-Reid ◽  
Jenny Ploeg ◽  
Amy Bartholomew ◽  
Lauren E Griffith ◽  
...  
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Service Use ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Home Care Services ◽  
Community Dwelling ◽  
Care Services ◽  
And Control ◽  
Community Dwelling Older Adults

Background: Multimorbidity, the co-existence of 2+ (or 3+) chronic diseases in an individual, is an increasingly common global phenomenon leading to reduced quality of life and functional status, and higher healthcare service use and mortality. There is an urgent need to develop and test new models of care that incorporate the components of multimorbidity interventions recommended by international organizations, including care coordination, interdisciplinary teams, and care plans developed with patients that are tailored to their needs and preferences. Purpose: To determine the effectiveness of a 6-month, community-based, multimorbidity intervention compared to usual home care services for community-dwelling older adults (age 65+ years) with multimorbidity (3+ chronic conditions) that were newly referred to and receiving home care services. Methods: A pragmatic, parallel, two-arm randomized controlled trial evaluated the intervention, which included in-home visits by an interdisciplinary team, personal support worker visits, and monthly case conferences. The study took place in two sites in central Ontario, Canada. Eligible and consenting participants were randomly allocated to the intervention and control group using a 1:1 ratio. The participants, statistician/analyst, and research assistants collecting assessment data were blinded. The primary outcome was the Physical Component Summary (PCS) score of the 12-Item Short-Form health survey (SF-12). Secondary outcomes included the SF-12 Mental Component Summary (MCS) score, Center for Epidemiological Studies of Depression (CESD-10), Generalized Anxiety Disorder (GAD-7), Self-Efficacy for Managing Chronic Disease, and service use and costs. Analysis of covariance (ANCOVA) tested group differences using multiple imputation to address missing data, and non-parametric methods explored service use and cost differences. Results: 59 older adults were randomized into the intervention (n = 30) and control (n = 29) groups. At baseline, groups were similar for the primary outcome and number of chronic conditions (mean of 8.6), but the intervention group had lower mental health status. The intervention was cost neutral and no significant group differences were observed for the primary outcome of PCS from SF-12 (mean difference: −4.94; 95% CI: −12.53 to 2.66; p = 0.20) or secondary outcomes. Conclusion: We evaluated a 6-month, self-management intervention for older adults with multimorbidity. While the intervention was cost neutral in comparison to usual care, it was not found to improve the PCS from SF-12 or secondary health outcomes. Recruitment and retention challenges were significant obstacles limiting our ability to assess intervention effectiveness. Yet, the intervention was grounded in internationally-endorsed recommendations and implemented in a practice setting (home care) viewed as a key upstream resource fostering independence in older adults. These features collectively support the identification of ways to recruit/retain older adults and test alternative implementation strategies for interventions that are based on sound principles of multimorbidity management.

An evaluation of contracted palliative care home care services in Ontario, Canada

2001 ◽  
Vol 24 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Allison M. Williams ◽  
Michelle V. Caron ◽  
Maria McMillan ◽  
Anne Litkowich ◽  
Noreen Rutter ◽  
...  
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Care Home ◽  
Home Care Services ◽  
Care Services

scholarly journals PELAYANAN HOME CARE TERHADAP TINGKAT KEMANDIRIAN KELUARGA DALAM MERAWAT ANGGOTA KELUARGA DENGAN DIABETES MELITUS TIPE 2

2017 ◽  
Vol 1 (1) ◽  
pp. 9
Author(s):  
Lia Meilianingsih ◽  
Ridwan Setiawan
Keyword(s):  
Treatment Group ◽  
Home Care ◽  
Family Members ◽  
Home Care Services ◽  
Control Group ◽  
Care Services ◽  
The Family ◽  
Before And After ◽  
Taking Care

ABSTRAKTujuan penelitian: Penelitian ini bertujuan untuk mengetahui pengaruh pelayanan home careterhadap tingkat kemandirian keluarga dalam merawat anggota keluarga dengan diabetesmelitus (DM) tipe 2 di Wilayah Kerja Puskesmas Pasirkaliki, Bandung. Metode: Desain penelitianmenggunakan quasi experiment dengan pendekatan pre- post-test control group design. Sampelberjumlah 27 orang untuk kelompok perlakuan dan 27 orang untuk kelompok kontrol. Teknikpengambilan sampel secara purposive sampling. Intervensi pelayanan home care dilakukan enamkali kunjungan. Kemandirian keluarga dalam merawat anggota keluarga dengan DM tipe 2 sebelumdan sesudah diberikan pelayanan home care dilakukan dengan uji statistik T test independent dandependent. Instrumen untuk menilai kemandirian keluarga dengan kuesioner tentang kemandiriankeluarga dari Kementrian Kesehatan. Hasil: Terdapat perbedaan yang bermakna pada tingkatkemandirian keluarga dalam merawat anggota keluarga dengan DM tipe 2 sebelum dan setelahdilakukan pelayanan home care pada kelompok perlakuan (p=0,00), selanjutnya terdapat perbedaanyang bermakna juga antara kelompok kontrol dan kelompok perlakuan (p=0,00). Diskusi: Untukmencapai hasil yang maksimal perlu peningkatan pelayanan keperawatan keluarga dalam bentukHome Care secara berkesinambungan sehingga kemandirian keluarga dalam mengenal danmengatasi masalah kesehatan di keluarganya semakin meningkat. Simpulan: pelayanan homecare dapat meningkatkan kemandirian keluarga dalam merawat anggota keluarga dengan DM tipe2.Kata Kunci: diabetes melitus tipe 2, home care, kemandirian keluargaABSTRACTObjectives: This study aimed to identify the effect of home care services on the levels of independenceof family in taking care of family members with type 2 diabetes mellitus (DM) at Pasirkaliki PublicHealth Centre, Bandung. Method: This study was quasi-experimental with pre-post-test approachcontrol group design. Samples were divided into treatment group and control group, each of whichconsisted of 27 people. They were taken using purposive sampling. Home care services interventioninvolved six visits. The independence of the family in taking care of family members with type 2DM before and after home care services was analyzed using independent and dependent t test.Result: There were signifi cant differences in the levels of independence of the family in taking careof family members with type 2 DM before and after the home care services in the treatment group(p=0.00). There were also signifi cant differences between the control group and the treatment group(p 0.00). Discussion: In order to achieve maximum results, it was necessary to improve familynursing services in the form of Home Care on an ongoing basis so that the independence of thefamily in identifying and addressing family health issues would increase. Conclusion: Home careservices could improve the independence of the family in taking care of family members with type 2DM.Keywords: type 2 diabetes mellitus, home care, independence of family.

Impact of an Oncology Palliative Care Clinic on Access to Home Care Services

2012 ◽  
Vol 30 (5) ◽  
pp. 425-431 ◽  
Author(s):  
Raymond W. Jang ◽  
Debika Burman ◽  
Nadia Swami ◽  
Jennifer Kotler ◽  
Subrata Banerjee ◽  
...  
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Home Care Services ◽  
Care Clinic ◽  
Care Services

scholarly journals Community Nurses’ Preparations for and Challenges in Providing Palliative Home Care: A Qualitative Study

2021 ◽  
Vol 18 (22) ◽  
pp. 11838
Author(s):  
Chien-Yi Wu ◽  
Yu-Hsuan Wu ◽  
Yi-Hui Chang ◽  
Min-Shiow Tsay ◽  
Hung-Cheng Chen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Critical Role ◽  
Home Care Services ◽  
Structured Interviews ◽  
Community Based ◽  
Palliative Home Care ◽  
Care Services ◽  
Leading Role ◽  
Study Results

Hospitals have played a leading role in providing palliative care in Taiwan as its care model has developed over the past few decades. However, earlier local studies in Taiwan showed that terminal patients prefer to die at home, highlighting the need to promote community-based palliative care instead of hospital-based care. Along with this shift, how community nurses provide palliative home care merits further exploration. This qualitative descriptive study aims to understand (1) how community nurses implement community-based palliative care, (2) what preparations are needed, and (3) what challenges they may face. Purposive sampling was used for recruiting nurses. We conducted one-on-one, in-depth, semi-structured interviews. Interview recordings were transcribed verbatim and analyzed using thematic analysis. Eight community nurses with a range of experience in palliative home care were interviewed. Four major themes emerged: (1) Opportunities, (2) Qualifications, (3) Support, and (4) Commitments. Psychological preparedness, well-developed professional capabilities, external assistance, and peer support motivate community nurses to offer community-based palliative care. As the requests for palliative home care services increase, community nurses play a critical role in palliative home care. Although the sample size is small and the findings retrieved from a small number of experiences might not be generalized to every region, the study results could inform future experience-sharing and workshop sessions to train more nurses for community-based care, expanding service coverage, and providing optimal palliative care.

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