Implementing Outcome Measures Within an Enhanced Palliative Care Day Care Model.
BACKGROUND
Specialist palliative care day care (SPDC) units provide an array of services to patients and their families and can increase continuity of care between inpatient and homecare settings. A multidisciplinary teamwork approach is emphasized, and different models of day care exist. Depending on the emphasis of care, the models can be social, medical, therapeutic, or mixed. We describe our experience of introducing an enhanced therapeutic specialist day care model and using both patient- and carer-rated tools to monitor patient outcomes.


METHODS
Validated tools used to monitor patients' progress were the Edmonton Symptom Assessment System, the Edmonton Functional Assessment Tool, Part A of the McGill Quality of Life (QoL) Index, and the Palliative Care Problem Severity Scale.


METHODS
Participating patients received multidisciplinary teamwork input over eight-week cycles of care and completed the validated tools.


RESULTS
A total of 70.6% of patients showed an improvement in their Edmonton Symptom Assessment System Symptom Distress Scores after one eight-week cycle. An improvement in Edmonton Functional Assessment Tool scores occurred in 53% and remained unchanged in 13% of patients. On a scale of 0-10, overall QoL improved in 56% of patients, remained unchanged in 18%, and worsened in 26%. Palliative Care Problem Severity Scale scores after an eight-week cycle improved in 58%.


CONCLUSIONS
This enhanced therapeutic model of SPDC allows for the tracking of progress toward specific goals and monitoring of patients' symptoms, functional status, QoL, and complexity. Retrospective analyses of validated tools show SPDC results in both maintenance and improvement of all parameters.
Department of Palliative Medicine, Milford Care Centre, Castletroy, Limerick, Republic of Ireland. Electronic address: isae.kilonzo@gmail.com.
Isae
I
Kilonzo
Department of Palliative Medicine, Milford Care Centre, Castletroy, Limerick, Republic of Ireland.
Michael
M
Lucey
Department of Palliative Medicine, Milford Care Centre, Castletroy, Limerick, Republic of Ireland.
Feargal
F
Twomey
D000368:Aged; D000369:Aged, 80 and over; D003631:Day Care, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010166:Palliative Care / Q000379:methods*; D010348:Patient Care Team; D011788:Quality of Life; D012720:Severity of Illness Index
Specialist palliative day care; patient-reported outcomes; quality improvement; therapeutic model; validated tools