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Is Inpatient Hospice Care Clinically Effective? Using Phase of Illness to Evaluate Care Outcomes for Patients Admitted to a Specialist Palliative Care Unit in Ireland

Journal Article


Abstract


  • Background: In health care, clinical effectiveness involves evaluating the degree to which clinical interventions achieve beneficial patient and caregiver outcomes. Objective: To evaluate the clinical effectiveness of care in a specialist palliative care unit (SPCU) in Ireland, including an analysis of the temporal relationship among admission, Phase of Illness and patient and family distress. Design/Measurements: A consecutive case series with prospectively collected admission data (n = 400). Using a casemix tool (Phase of Illness), pain, other symptoms, psychological and family distress, and performance status were documented on admission and then daily by medical staff. Results: Three hundred forty-two (85%) patients had complete data recorded on day 1. After admission, there were linear correlations between days since admission and progressive improvements in pain (Cramer's V = 0.131, p < 0.001), other symptoms (V = 0.206, p < 0.001), psychological distress (V = 0.101, p < 0.001), and family distress (V = 0.124, p < 0.001). Forty-three percent were in an unstable phase on admission. Nearly two thirds (60.7%) of these unstable patients converted to a stable phase within 48 hours of admission. Over the first 72 hours, 70.7% of unstable patients converted to a stable phase. There was also a significant correlation between phase stabilization and pain and symptom control (p = 0.007). Stable phase over the first 4 days and first 14 days was associated with significantly higher performance status. Conclusion: This study demonstrates the significant clinical effectiveness of SPCU admission across the different aspects of patient and family care.

UOW Authors


  •   Lucey, Michael (external author)
  •   O'Reilly, Martina (external author)
  •   Currow, David
  •   Eagar, Kathleen
  •   Walsh, Declan (external author)
  •   Conroy, Marian (external author)
  •   Twomey, Feargal (external author)
  •   O'Reilly, Val (external author)
  •   Doherty, Mairéad (external author)
  •   Coffey, Siobhain (external author)
  •   Sheridan, John (external author)
  •   Moran, Sue (external author)

Publication Date


  • 2020

Citation


  • M. Lucey, M. O'Reilly, D. Currow, K. Eagar, D. Walsh, M. Conroy, F. Twomey, V. O'Reilly, M. Doherty, S. Coffey, J. Sheridan & S. Moran, "Is Inpatient Hospice Care Clinically Effective? Using Phase of Illness to Evaluate Care Outcomes for Patients Admitted to a Specialist Palliative Care Unit in Ireland", Journal of Palliative Medicine 23 4 (2020) 535-541.

Scopus Eid


  • 2-s2.0-85082561511

Ro Metadata Url


  • http://ro.uow.edu.au/ahsri/1033

Number Of Pages


  • 6

Start Page


  • 535

End Page


  • 541

Volume


  • 23

Issue


  • 4

Place Of Publication


  • United States

Abstract


  • Background: In health care, clinical effectiveness involves evaluating the degree to which clinical interventions achieve beneficial patient and caregiver outcomes. Objective: To evaluate the clinical effectiveness of care in a specialist palliative care unit (SPCU) in Ireland, including an analysis of the temporal relationship among admission, Phase of Illness and patient and family distress. Design/Measurements: A consecutive case series with prospectively collected admission data (n = 400). Using a casemix tool (Phase of Illness), pain, other symptoms, psychological and family distress, and performance status were documented on admission and then daily by medical staff. Results: Three hundred forty-two (85%) patients had complete data recorded on day 1. After admission, there were linear correlations between days since admission and progressive improvements in pain (Cramer's V = 0.131, p < 0.001), other symptoms (V = 0.206, p < 0.001), psychological distress (V = 0.101, p < 0.001), and family distress (V = 0.124, p < 0.001). Forty-three percent were in an unstable phase on admission. Nearly two thirds (60.7%) of these unstable patients converted to a stable phase within 48 hours of admission. Over the first 72 hours, 70.7% of unstable patients converted to a stable phase. There was also a significant correlation between phase stabilization and pain and symptom control (p = 0.007). Stable phase over the first 4 days and first 14 days was associated with significantly higher performance status. Conclusion: This study demonstrates the significant clinical effectiveness of SPCU admission across the different aspects of patient and family care.

UOW Authors


  •   Lucey, Michael (external author)
  •   O'Reilly, Martina (external author)
  •   Currow, David
  •   Eagar, Kathleen
  •   Walsh, Declan (external author)
  •   Conroy, Marian (external author)
  •   Twomey, Feargal (external author)
  •   O'Reilly, Val (external author)
  •   Doherty, Mairéad (external author)
  •   Coffey, Siobhain (external author)
  •   Sheridan, John (external author)
  •   Moran, Sue (external author)

Publication Date


  • 2020

Citation


  • M. Lucey, M. O'Reilly, D. Currow, K. Eagar, D. Walsh, M. Conroy, F. Twomey, V. O'Reilly, M. Doherty, S. Coffey, J. Sheridan & S. Moran, "Is Inpatient Hospice Care Clinically Effective? Using Phase of Illness to Evaluate Care Outcomes for Patients Admitted to a Specialist Palliative Care Unit in Ireland", Journal of Palliative Medicine 23 4 (2020) 535-541.

Scopus Eid


  • 2-s2.0-85082561511

Ro Metadata Url


  • http://ro.uow.edu.au/ahsri/1033

Number Of Pages


  • 6

Start Page


  • 535

End Page


  • 541

Volume


  • 23

Issue


  • 4

Place Of Publication


  • United States