Measuring Palliative Care Outcomes Standardised assessment & outcome measurement

WHY PCOC EXISTS PCOC aims to embed nationally standardised clinical assessments and point-of-care data collection into daily practice Assessments are ‘vital signs’ for palliative care In real time , for use in planning and delivering patient care pcoc.org.au

WHY PCOC EXISTS To drive quality and outcome improvement With a feedback loop to individual services Identifying individual improvement opportunities Facilitate service to service benchmarking University of Wollongong – Professor Kathy Eagar Queensland University of Technology – Professor Patsy Yates University of Western Australia – A/Professor Claire Johnson University of Technology Sydney – Professor David Currow pcoc.org.au

FIVE CORE CLINICAL ASSESSMENT TOOLS Phase RUG-ADL AKPS PCPSS SAS Eagar et al, 2004 Fries et al, 1994 Abernethy et al, 2005 Aoun et al, 2004 Functional status Pain and other symptoms PCOC assessment tools are used and work together to inform a care plan and demonstrate outcomes. The tools assess the key domains of palliative care: the phase of illness, the patient’s functioning and performance, pain and other common symptoms, the patient’s psychological or spiritual distress and family or carer distress associated with the patient’s illness. Phase describes the patient needs. RUG describes dependency and the resources required for care. AKPS describes performance. PCPSS is a summary of the severity of problems of the patient and family. It is a clinician rated tool. SAS tells us about 7 specific symptoms and the severity of distress caused by each symptom. It is a patient rated tool. Links to papers in Clinical Manual page 34. pcoc.org.au

ASSESSMENT PROTOCOL On Admission On Admission Patient contact in the hospital consultative setting g Patient contact in the community setting, by phone or in -person A minimum of daily in the inpatient setting The goal is to incorporate these assessment tools into routine practice and to use the assessments to guide care. It may be helpful to view assessments as palliative care observations Assessments can be conducted in-person or via the telephone. Assessments are conducted daily or at contact to detect changes in patient and family/carer needs. The 3 points of assessment on this slide gather the information about the patient’s outcomes; admission to palliative care, change in patient condition (phase change) and at discharge. A common error is not assessing the patient on discharge. Without this information patient outcomes at discharge are unknown. When a patient dies no further assessments are undertaken. At change in plan of care (new phase) At discharge pcoc.org.au

PATIENT INFORMATION RECORDED Setting of care Episode Setting of care Episode Demographics Demographics Assessments Resources: PCOC forms, episode and assessment There are 3 levels of information collected about the patient. This information works together to describe patient outcomes. Patient is the demographic information. It is collected as part of the administrative processes in the admission of a patient. Episode is about the location of the patient and the type of palliative care service. Phase is about the clinical condition of patient and family. To capture this, 5 assessment tools are used. The information that is collected also helps to give a national picture of what’s happening ie. an increase in patients with non-malignant diseases the most common diseases etc. pcoc.org.au

WHAT HAPPENS TO THE INFORMATION YOU COLLECT ABOUT YOUR PATIENTS? Picture: William Iven: Unsplash: https://unsplash.com/search/photos/reports pcoc.org.au

FROM ASSESSMENTS TO OUTCOMES Assess patient and family/carer Track symptoms & problems Plan & review care Outcome Report based on assessment scores Patient care benchmarked Daily, at contact, routinely How does it all work together? The PCOC program itself is a quality improvement program that reflects what is happening in your service through measuring the care provided. pcoc.org.au

1 benchmark on timeliness of care MEASURING OUTCOMES Focus is on individual patient’s outcomes regardless of the setting of care. There are 20 benchmarks: 1 benchmark on timeliness of care 1 benchmark on responsiveness to urgent needs 6 benchmarks on pain management 9 benchmarks on symptom management 3 benchmarks on family/carer problems This slide shows the Outcome Measures in summary. PCOC holds annual benchmarking workshops to facilitate communities of practice. The focus of outcome measures is to measure clinically important domains of care that are amenable to intervention. pcoc.org.au

PCOC raises the profile of palliative care and gives public recognition of services meeting every benchmark Academic publications Letters and media releases congratulating high performing services Conferences – helping clinicians to prepare papers on their own service results pcoc.org.au

BENEFITS FOR CLINICIANS Track and respond to symptoms and problems Standard assessment & communication ‘Vital Signs’ Baseline assessment & a snapshot of patient needs Benefits also include; Establishes a common language Assessments drive the focus of care Acknowledges carer/family as part of the unit of care Helps in identifying needs based care of patient and family Establishes and standardises expected responses to the care provided Enables clinical audit The opportunity to benchmark both internally (within the organisation), externally (nationally with palliative care services participating in PCOC and identified “like” services) The assessment tools provide a snapshot of the needs of the patient and family. The assessment scores provide information on the resources required to provide care and the resources required to operate the service. Provide examples such as equipment and staff or skill mix. In addition assessment tools give the casemix components (phase & rug, plus age). If the assessments are embedded into practice and reflective of patient need then funding will be accurate. Casemix classifications provide the health care industry with a consistent method of classifying types of patients, their treatment and associated costs. In popular usage, casemix refers to the mix of types of patients treated by a hospital or other health care facility (Eagar and Hindle 1994). Resources: PCOC website ABF and Casemix webpages Better patient experience & Improved outcomes of care pcoc.org.au

BENEFITS FOR PATIENTS AND FAMILIES Routine assessment of the unique needs of the patient, family and carers Patient, family & carers are part of decision making & care is driven by need The palliative care service measures and improves the care it provides Benefits also include; The assessment tools provide a snapshot of the needs of the patient and family. Assists in a seamless service between home, hospital and palliative care unit. Enhances communication between patients, families and clinicians. Better patient experience & Improved outcomes of care pcoc.org.au

Clinical assessments are used to KEY MESSAGE Clinical assessments are used to Prove Patient Outcomes Improve Patient Outcomes This key message is very important. pcoc.org.au

KEY MESSAGE Implementation of the PCOC model has led to statistically and clinically significant improvements in patient and carer outcomes This key message is very important. pcoc.org.au

www.pcoc.org.au

KEY RESOURCES www.PCOC.org.au Implementing, embedding and sustaining PCOC Guide for services and Organisations Assessment and Response Protocol Guide for use of the assessment framework Self-Directed Education Package Aid local implementation, embedding and sustaining Essentials course for clinicians and managers Education on the use of assessments and outcome reports

PCOC is a national palliative care project funded by the Australian Government Department of Health Thank You pcoc.org.au Prepared by Clapham S for the Palliative Care Outcomes Collaboration (2018) Australian Health Services Research Institute (AHSRI), University of Wollongong, NSW 2522 Australia. © PCOC 2018 For further information please view the resources contained in the PCOC Clinical Manual, go to www.pcoc.org.au, or contact your PCOC Facilitator