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Roshan Perera HNZ presentation
11
Dr Roshan Perera and Dr Helen Moriarty
University of Otago Wellington.29 October 2014
Quality Indicators for
Assessment of
Palliative Care
provision in NZ
Roshan Perera HNZ presentation
2
Overview
The ImPaCT project
The Indicator “Suites”
Future plans
29 October 2014
Roshan Perera HNZ presentation
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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
Roshan Perera HNZ presentation
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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
Roshan Perera HNZ presentation
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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
Roshan Perera HNZ presentation
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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
Roshan Perera HNZ presentation
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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
Roshan Perera HNZ presentation
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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
Roshan Perera HNZ presentation
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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
Roshan Perera HNZ presentation
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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
Roshan Perera HNZ presentation
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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
Roshan Perera HNZ presentation
1529 October 2014
Roshan Perera HNZ presentation
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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
Roshan Perera HNZ presentation
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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
Roshan Perera HNZ presentation
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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
Roshan Perera HNZ presentation
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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
Roshan Perera HNZ presentation
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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
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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
Roshan Perera HNZ presentation
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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
Roshan Perera HNZ presentation
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Acknowledgements
Te Omanga Hospice – staff, volunteers, patients/carers, GPs, Trustees/Board
Hospice New Zealand
Palliative Care Council
29 October 2014