B1 - Medicine Management

Roshan Perera HNZ presentation

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Dr Roshan Perera and Dr Helen Moriarty

University of Otago Wellington.29 October 2014

Quality Indicators for

Assessment of

Palliative Care

provision in NZ


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Overview

The ImPaCT project

The Indicator “Suites”

Future plans

29 October 2014


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The ImPaCT project

TOH: planned evolution of an integrated model of care provision

Action research project for evaluation of process change and impact on quality of care • Qualitative and quantitative arms for

empirical research • Output incl: 40 Quality measures

within 6 suites of indicators for PC quality assessment

29 October 2014


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‘Ground-up’ approach

Point of difference • Empirical data for indicator selection not

always readily available• Often top-down approaches, using expert

consensus• Research had explicit intention of identifying

areas suitable for indicator developmentRelevance: addresses areas identified as

important by stakeholders

Engages field workers and end-users

Stakeholder ownership and confidence• Measure what matters29 October 2014


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Builds on existing quality efforts Purposively constructedTake into account the feasibility of routine

data collection and collation in community

settingsFit for purposeOrganised and linked ‘functionally’ rather

than theoreticallyApplicable for assessment of quality of

care provision across a variety of settings 29 October 2014


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Indicator developmentEmpirical research from ImPacT project

highlighted challenges to integrated community-based palliative care provision• Confidence and Competence (includes scope of

generalist vs specialist care and timing of

transition)

• Workload, time constraints and responsiveness

• Continuity of care; communication and

reporting

• Access to resources, equipment, support

services

• Capacity building and education

• Organisational change

29 October 2014


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Topic areas and indicators derived from the identified challenges• Effective care• Timely access to health care• Communication• Continuity of care and access to support

services and equipment• Responsiveness to family/carer needs• Education and capacity

Numerators/Denominators and caveats specified

29 October 2014

Indicator development


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A greater truth? Quality issues consistent with the international

literature• Improved communication and capacity building• Clear definition of roles/responsibilities/lines of

reporting• Tech skills and holistic care• Ready access to specialist PC

Consistent with the consensus indicators and outcome measures developed by other means

Synergy in topic areas across the various approaches taken – potentially suggests a ‘greater truth’ evident29 October 2014


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Why indicator “suites”

Indicators focus on discrete areas (pin-pricks of light)

Clusters of related indicators provide a wider beam of illumination onto a particular aspect of care

Enables comprehensive review of the aspect of care in question29 October 2014


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Topic areas for the indicator suites

Effective CareTimely accessCommunicationContinuity of care; community support and

support servicesResponsiveness to family /carer needsEducation and capacity

29 October 2014


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Suite 1: Effective care• Clinical symptom control and assessment• Review of symptom control• Clinical management documentation

Suite 2: Timely access to health care• Service availability and response to

office/practice, home visit requests, phone calls and after-hours contact

• Service availability and response to requests for prescriptions, referral, social support, equipment and certification

The Indicators

29 October 2014


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Suite 3: Communication• Documentation of communication and

decisions within team, with patient/carer, and external services (incl GP)

Suite 4: Support for maintenance of continuity of care; and for accessing support services including social support and required equipment • Documentation to enable access to necessary

services incl social support, external providers and equipment

• Provision of complete and appropriate documentation for certification 29 October 2014


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Suite 5: Responsiveness to family/carer needs• Identification and review of needs • Appropriate documentation and ability to track

responsiveness• F/U and addressing of bereavement/family

satisfaction • Positive impact on the community (donations)

Suite 6: Education and capacity• Availability of an appropriately and highly skilled

workforce, and sufficient range of PC services to meet need

(Id and resolution of workforce and service requirements, and shortfalls; provision of education by locational specialist workforce)

29 October 2014


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Suite 5 Topic: Family Needs

Aspect of care: Responsiveness

Addresses need for:• Systems and processes which

• Identify family needs and bereavement support• Flag need for bereavement support prior to 6

weeks• Maintain accurate records

Unit of analysis• Individual practice or GP• Rest home/ARC• Hospice/specialist team

29 October 2014


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Suite 5 Denominator:

• Palliative care patients enrolled at a GP practice and under Hospice or Rest Home care

Numerators

Indicator 1:• Documentation of family/carer needs at first

contact• Itemisation of identified needs at first contact• Documentation of review of family/carer needs

at (x interval) including need for early bereavement support

• Documented action on identified needs Indicator 2:

• Patient dies at negotiated place of death29 October 2014


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Numerators

Indicator 3:• Bereavement support f/u at 6/52 documented

Indicator 4:• Family satisfaction with service provision

documented• F/U within 2/52 of family issues with service

provision documented

Indicator 5:• Donations to Hospice/Volunteer workforce

Suite 5

29 October 2014


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So What?

Comparison of care provision & benchmarking standards of

care across PC service delivery settings, to:

• Compare current care to aspirational statements

• Identify gaps in quality/ safety/ equity of access

• Investigate extent and impact of variability in PC service

provision

• Foster improvement initiatives and inform change

• Foster a quality culture: feasibility and benefits of routine

use Pilot to gather data to enable target setting

29 October 2014


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ImPaCT project quantitative arm

GP survey

National benchmarking,

effectiveness and future national

standard setting (HRC grant

application)

Sandpit meeting (2015)

Future plans

29 October 2014

Helen Moriarty

Could also mention that we have taken workforce development seriously in doing this research : a medcal student has been involved and that a PC advanced trainee is doing an associated project?

Helen Moriarty

and maybe we should specifically state that we are interested in national benchmarking, socteffectiveness and future national standard setting ?


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Discussion

What Indicators of Quality Service are

currently in use and how are they used?

What are the barriers to routine use?

• Eg for routine audit and QA/QI purposes

• GP survey : what should we ask them?

Any feedback on intended questions?

29 October 2014


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An exercise for you to do: In small groupsEach discuss a recent bereavement

episode that you were involved with Identify care aspects that might have gone

differently if an “early warning” or quality

indicator were routinely in place.What would the warning/indicator have

been?What aspect of service would have been

impacted? 29 October 2014


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Acknowledgements

Te Omanga Hospice – staff, volunteers, patients/carers, GPs, Trustees/Board

Hospice New Zealand

Palliative Care Council

29 October 2014

Helen Moriarty

add Hospice NZ and also PCC for the inviation

Health & Medicine

B1 - Medicine Management