TY - JOUR

T1 - Improving regional care in the last year of life by setting up a pragmatic evidence-based Plan–Do–Study–Act cycle

T2 - results from a cross-sectional survey

AU - On behalf of The CoRe‑Net Co‑applicants

AU - Voltz, Raymond

AU - Dust, Gloria

AU - Schippel, Nicolas

AU - Hamacher, Stefanie

AU - Payne, Sheila

AU - Scholten, Nadine

AU - Pfaff, Holger

AU - Rietz, Christian

AU - Strupp, Julia

AU - Albus, Christian

AU - Ansmann, Lena

AU - Jessen, Frank

AU - Karbach, Ute

AU - Kuntz, Ludwig

AU - Schubert, Ingrid

AU - Schulz-Nieswandt, Frank

AU - Stock, Stephanie

PY - 2020/11/30

Y1 - 2020/11/30

N2 - Objectives: To set up a pragmatic Plan–Do–Study–Act cycle by analysing patient experiences and determinants of satisfaction with care in the last year of life. Design: Cross-sectional postbereavement survey. Setting: Regional health services research and development structure representing all health and social care providers involved in the last year of life in Cologne, a city with 1 million inhabitants in Germany. Participants: 351 bereaved relatives of adult decedents, representative for age and gender, accidental and suspicious deaths excluded. Results: For the majority (89%) of patients, home was the main place of care during their last year of life. Nevertheless, 91% of patients had at least one hospital admission and 42% died in hospital. Only 60% of informants reported that the decedent had been told that the disease was leading to death. Hospital physicians broke the news most often (58%), with their communication style often (30%) being rated as ‘not sensitive’. Informants indicated highly positive experiences with care provided by hospices (89% ‘good’) and specialist palliative home care teams (87% ‘good’). This proportion dropped to 41% for acute care hospitals, this rating being determined by the feeling of not being treated with respect and dignity (OR=23.80, 95% CI 7.503 to 75.498) and the impression that hospitals did not work well together with other services (OR=8.37, 95% CI 2.141 to 32.71). Conclusions: Following those data, our regional priority for action now is improvement of care in acute hospitals, with two new projects starting, first, how to recognise and communicate a limited life span, and second, how to improve care during the dying phase. Results and further improvement projects will be discussed in a working group with the city of Cologne, and repeating this survey in 2 years will be able to measure regional achievements. Trial registration number: DRKS00011925.

AB - Objectives: To set up a pragmatic Plan–Do–Study–Act cycle by analysing patient experiences and determinants of satisfaction with care in the last year of life. Design: Cross-sectional postbereavement survey. Setting: Regional health services research and development structure representing all health and social care providers involved in the last year of life in Cologne, a city with 1 million inhabitants in Germany. Participants: 351 bereaved relatives of adult decedents, representative for age and gender, accidental and suspicious deaths excluded. Results: For the majority (89%) of patients, home was the main place of care during their last year of life. Nevertheless, 91% of patients had at least one hospital admission and 42% died in hospital. Only 60% of informants reported that the decedent had been told that the disease was leading to death. Hospital physicians broke the news most often (58%), with their communication style often (30%) being rated as ‘not sensitive’. Informants indicated highly positive experiences with care provided by hospices (89% ‘good’) and specialist palliative home care teams (87% ‘good’). This proportion dropped to 41% for acute care hospitals, this rating being determined by the feeling of not being treated with respect and dignity (OR=23.80, 95% CI 7.503 to 75.498) and the impression that hospitals did not work well together with other services (OR=8.37, 95% CI 2.141 to 32.71). Conclusions: Following those data, our regional priority for action now is improvement of care in acute hospitals, with two new projects starting, first, how to recognise and communicate a limited life span, and second, how to improve care during the dying phase. Results and further improvement projects will be discussed in a working group with the city of Cologne, and repeating this survey in 2 years will be able to measure regional achievements. Trial registration number: DRKS00011925.

KW - Health services research

KW - 1506

KW - 1704

KW - adult palliative care

KW - quality in health care

KW - change management

U2 - 10.1136/bmjopen-2019-035988

DO - 10.1136/bmjopen-2019-035988

M3 - Journal article

VL - 10

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 11

M1 - e035988

ER -