Title: Improving care for people who are frail, and have chronic illnesses as they move towards the end of life: the integrated community palliative partnership project.
Funder: Dunhill Medical Trust

Abstract: Background There is abundant evidence that many people with chronic illnesses, particularly older people, attend accident and emergency departments and are admitted to hospital when earlier and better planned care, including integrated palliative care in the community could have prevented this[1]. Uncontrolled symptoms play a major factor in admission at the end of life[2]. It is also clear that organising services around community hubs, according to the Wagner Chronic Disease Model[3], linked with general and specialist services, reduces hospital admissions, and improves care, patient satisfaction, and quality of life[4]. A recently published literature review[5] (commissioned by the World Health Organization) of 72 systematic reviews on service delivery models to maximise quality of life (QoL) for older people at the end-of-life found that two service delivery models with different target outcomes – Integrated Palliative Care and Integrated Geriatric Care models – were effective in optimising QoL for older people nearing the end-of-life. Currently, there is a paucity of such services in the UK. Aim To explore the scope, feasibility and potential scalability of an integrated community palliative partnership (ICPP) incorporating specialist palliative care, primary care, social care and specialised nursing support for older people with advanced disease in primary-care homes in Southwark and Lambeth council area. Methods and analysis This participatory study comprises two phases. In phase 1, we will conduct a literature review to synthesize the evidence on the clinical and cost effectiveness of integrated palliative care services for care home residents with chronic illnesses. This theory-driven understanding will provide the basis for phase 2, where we will employ participatory approaches[6] informed by co-design principles[7] to outline the processes and outcomes of the ICPP (including economic modelling[8]), which will then be the subject of a subsequent feasibility and evaluation study. More specifically, we will conduct individual interviews with different stakeholders (including patients, carers, care homes staff, GPs, palliative care specialists and commissioners) to explore their experiences of community-based palliative care and facilitated group discussions to develop a co-designed model for an ICPP. This project will follow the MRC guidance for developing and evaluating complex interventions[9]. Deliverables The paucity of integrated generalist and specialist services in the community for older people with advanced illness is well recognised. This study addresses this gap. The findings from this project will inform the design and conduct of a feasibility study, and subsequent evaluation and implementation of the ICPP.

Lay abstract: There is a lack of healthcare services in the community for older people with advanced illness. The project addresses this gap and provides the basis for developing a new way of delivering healthcare to care home residents with advanced illness. The new service combines palliative care, primary care, social care and specialised nursing support. It puts patients at the centre of their care, and delivers care in the place where the older person lives. It will prevent unplanned, and stressful, multiple hospital and emergency admissions. The project will identify what is required for a successful rollout of the service on a large scale. It will also demonstrate how the service’s cost effectiveness can be evaluated. The findings will be transferable to people with advanced illness in their own homes.

Research activity codes: 7.2 END OF LIFE CARE
Health categories: GENERIC HEALTH RELEVANCE