A need for more integrated palliative care?
Findings from new research supported by King’s Health Partners have highlighted the need for greater integration of palliative care in community hospitals to improve quality of life for patients.
The first national study to examine the characteristics of patients in community hospitals in England, has found they were mainly older patients living with multiple conditions. The study also examined mortality rates in these hospitals and the factors associated with patient deaths and found that over one in four died within a year of their admission. This highlights the need for greater integration of palliative care in community hospitals, established to care for people in transition between hospital and home.
The study, published in BMC Medicine, is part of the research carried out by the Symptom and Psychosocial Assessment and Communication Evaluation (SPACE) group, a joint project between the Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation at King’s College London and Sussex Community NHS Foundation Trust. It was led by Dr Catherine Evans, Clinical Reader in Palliative Care and Honorary Nurse Consultant Sussex Community NHS Foundation Trust and is funded by a Health Education England/National Institute for Health Research (HEE/NIHR) Senior Clinical Lectureship held by Dr Evans.
This study involved 76,704 adults admitted to 220 community hospitals over a one-year period in 2016 and used national NHS data on hospital admissions linked with death registration data. The study found patients in this group were on average 81 years and living with multiple chronic progressive conditions. 77% of patients had an unplanned hospital admission. Over one in four patients died within a year of being admitted to a community hospital. The risk of dying increased in those with multiple conditions, cancer and noncancer respiratory conditions, dementia, and liver disease.
The study findings showed a shift in the emphasis of care in community hospitals to better meet the needs of older patients. With an ageing population, the traditional focus on rehabilitation and recovery has changed with need for greater integration of palliative care to improve quality of life for patients and anticipate and plan for end of life. These findings challenge views of community hospitals, with relatively low technology, as managing seemingly simplistic care needs. The research team concluded that a model of integrated care between community hospitals, geriatric care and palliative care, and a skilled workforce to manage multiple care needs is required to deliver the best possible care.
Dr Catherine Evans, Chief Investigator on this study, said:
Patients admitted to community hospitals are in transition between hospital and home require intermediate care. Our research showed this group were mainly older people with chronic progressive disease and multiple conditions. Over one in four were in the last year of life.
Our findings revealed requirement for integrated geriatric and palliative care to support these patients with multiple care needs. Understanding care needs at a population level is vital to identify policy priorities to deliver high quality care. This work adds to the growing body of evidence of the need for more integrated and joined up models of care among our health services.
Read the full paper Characteristics and mortality rates among patients requiring intermediate care: a national cohort study using linked databases on BMC Medicine.
You can find out more about the SPACE project here.