More older adults died at their preferred place after implementation of a transmural care pathway for older adults at the end of life: a before-after study
Abstract Background To improve transmural palliative care for older adults acutely admitted to hospital, the PalliSupport intervention, comprising an educational programme and transmural palliative care pathway, was developed. This care pathway involves timely identification of palliative care needs...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | BMC Palliative Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12904-023-01218-0 |
| _version_ | 1827875350992912384 |
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| author | Iris van Doorne Marike A. de Meij Juliette L. Parlevliet Vera M. W. van Schie Dick L. Willems Bianca M. Buurman Marjon van Rijn |
| author_facet | Iris van Doorne Marike A. de Meij Juliette L. Parlevliet Vera M. W. van Schie Dick L. Willems Bianca M. Buurman Marjon van Rijn |
| author_sort | Iris van Doorne |
| collection | DOAJ |
| description | Abstract Background To improve transmural palliative care for older adults acutely admitted to hospital, the PalliSupport intervention, comprising an educational programme and transmural palliative care pathway, was developed. This care pathway involves timely identification of palliative care needs, advance care planning, multidisciplinary team meetings, warm handover, and follow-up home visits. With this study, we evaluate changes in patient-related outcomes and transmural collaboration after implementation of the care pathway. Methods We conducted a before-after study, in which we compared 1) unplanned hospital admission and death at place of preference and 2) transmural collaboration before implementation, up to six months, and six to 18 months after implementation. Data from palliative care team consultations were collected between February 2017 and February 2020 in a teaching hospital in the Netherlands. Results The palliative care team held 711 first-time consultations. The number of consultation, as well as the number of consultations for patients with non-malignant diseases, and consultations for advance care planning increased after implementation. The implementation of the pathway had no statistically significant effect on unplanned hospitalization but associated positively with death at place of preference more than six months after implementation (during/shortly after adjusted OR: 2.12; 95% CI: 0.84–5.35; p-value: 0.11, long term after adjusted OR: 3.14; 95% CI: 1.49–6.62; p-value: 0.003). Effects on transmural collaboration showed that there were more warm handovers during/shortly after implementation, but not on long term. Primary care professionals attended multidisciplinary team meetings more often during and shortly after implementation, but did not more than six months after implementation. Conclusions The pathway did not affect unplanned hospital admissions, but more patients died at their place of preference after implementation. Implementation of the pathway increased attention to- and awareness for in-hospital palliative care, but did not improve transmural collaboration on long-term. For some patients, the hospital admissions might helped in facilitating death at place of preference. |
| first_indexed | 2024-03-12T17:06:32Z |
| format | Article |
| id | doaj.art-d9f3e9ac19c8464bacddb5021977dcdc |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-03-12T17:06:32Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-d9f3e9ac19c8464bacddb5021977dcdc2023-08-06T11:27:36ZengBMCBMC Palliative Care1472-684X2023-08-0122111010.1186/s12904-023-01218-0More older adults died at their preferred place after implementation of a transmural care pathway for older adults at the end of life: a before-after studyIris van Doorne0Marike A. de Meij1Juliette L. Parlevliet2Vera M. W. van Schie3Dick L. Willems4Bianca M. Buurman5Marjon van Rijn6Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of AmsterdamPalliative and Supportive Care Team, Oncology Center Amsterdam, OLVGDepartment of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of AmsterdamDepartment of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of AmsterdamGeneral Practice, Section of Medical Ethics, Amsterdam UMC Location University of AmsterdamDepartment of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of AmsterdamDepartment of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of AmsterdamAbstract Background To improve transmural palliative care for older adults acutely admitted to hospital, the PalliSupport intervention, comprising an educational programme and transmural palliative care pathway, was developed. This care pathway involves timely identification of palliative care needs, advance care planning, multidisciplinary team meetings, warm handover, and follow-up home visits. With this study, we evaluate changes in patient-related outcomes and transmural collaboration after implementation of the care pathway. Methods We conducted a before-after study, in which we compared 1) unplanned hospital admission and death at place of preference and 2) transmural collaboration before implementation, up to six months, and six to 18 months after implementation. Data from palliative care team consultations were collected between February 2017 and February 2020 in a teaching hospital in the Netherlands. Results The palliative care team held 711 first-time consultations. The number of consultation, as well as the number of consultations for patients with non-malignant diseases, and consultations for advance care planning increased after implementation. The implementation of the pathway had no statistically significant effect on unplanned hospitalization but associated positively with death at place of preference more than six months after implementation (during/shortly after adjusted OR: 2.12; 95% CI: 0.84–5.35; p-value: 0.11, long term after adjusted OR: 3.14; 95% CI: 1.49–6.62; p-value: 0.003). Effects on transmural collaboration showed that there were more warm handovers during/shortly after implementation, but not on long term. Primary care professionals attended multidisciplinary team meetings more often during and shortly after implementation, but did not more than six months after implementation. Conclusions The pathway did not affect unplanned hospital admissions, but more patients died at their place of preference after implementation. Implementation of the pathway increased attention to- and awareness for in-hospital palliative care, but did not improve transmural collaboration on long-term. For some patients, the hospital admissions might helped in facilitating death at place of preference.https://doi.org/10.1186/s12904-023-01218-0Palliative careTransmural palliative care pathwayBefore-after study |
| spellingShingle | Iris van Doorne Marike A. de Meij Juliette L. Parlevliet Vera M. W. van Schie Dick L. Willems Bianca M. Buurman Marjon van Rijn More older adults died at their preferred place after implementation of a transmural care pathway for older adults at the end of life: a before-after study BMC Palliative Care Palliative care Transmural palliative care pathway Before-after study |
| title | More older adults died at their preferred place after implementation of a transmural care pathway for older adults at the end of life: a before-after study |
| title_full | More older adults died at their preferred place after implementation of a transmural care pathway for older adults at the end of life: a before-after study |
| title_fullStr | More older adults died at their preferred place after implementation of a transmural care pathway for older adults at the end of life: a before-after study |
| title_full_unstemmed | More older adults died at their preferred place after implementation of a transmural care pathway for older adults at the end of life: a before-after study |
| title_short | More older adults died at their preferred place after implementation of a transmural care pathway for older adults at the end of life: a before-after study |
| title_sort | more older adults died at their preferred place after implementation of a transmural care pathway for older adults at the end of life a before after study |
| topic | Palliative care Transmural palliative care pathway Before-after study |
| url | https://doi.org/10.1186/s12904-023-01218-0 |
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