Background Day Hospice underwent review and subsequent service redesign as referrals and attendance had dropped and new models of care were emerging. The redesign incorporated implementation of outcome measures to evaluate impact.
Aim Move from a social model to a therapeutic programme to:
empower patients to ‘live well’ with their illness
improve symptom control and self-management
offer education, exercise, relaxation and support
reach more people.
Start measuring outcomes using the OACC suite.
Methods The Day Hospice therapeutic programme runs weekly for 20 patients over 12 weeks. Patients have individualised assessment with nurse/physiotherapist, then embark on a structured programme with ongoing 1:1 support from the MDT. Measures recorded: IPOS and ‘views on care’ 0 and 6 weeks, Barthel and phase of illness every visit. Patients are discussed at MDT meeting at 0 and 12 weeks
Over 10 months, 156 referrals, 78 of whom accessed the service
Average 18 patients on waiting list
72% average attendance/week
71% malignancy; 29% non-malignant condition
IPOS data shows mixed scores but tool clinically useful for identifying patients’ unmet needs
Quality of life increased from 3.0 to 4.3 despite overall deteriorating health
Patients/carers report Day Hospice makes a significant difference with most saying it gives ‘a lot of benefit’
Patterns in phase of illness have emerged and may help to guide decision making regarding follow-up
100% patients discharged from hospice, had consecutive ‘stable’ status throughout care
All patients needing specialist follow-up had ‘deteriorating’ or ‘unstable’ phase during programme.
Conclusions The redesign has been successful and patient feedback good. Measuring hospice outcomes remains challenging but our experience of the OACC suite has been positive and we are now implementing Karnofsky. A clearer pattern, particularly with IPOS may emerge with more data. However, we may need to wait to benchmark against other similar services or a baseline population.
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