Quality in End-of-Life Care
The overall aim of this research project, supported by the Lishman Health Foundation, was to improve the quality of end of life (EOL) care in Western Australian regional communities. The central and unique role of general practitioners (GPs) in providing palliative and end-of-life care in community settings was demonstrated in both the qualitative and quantitative components of the present project.
GPs were highly involved in a range of end-of-life services, coordination of the care, discussions of end-of-life issues and planning for death. GPs also identified a number of management issues, including the high prevalence for a number of symptoms in patients’ last week of life, the challenges in addressing these symptoms, and the high percentage of home residents unable to die at home as they wished.
In terms of future directions, a self-reinforcing process of routine data collection, evaluation and feedback on clinical performance is recognised as the most effective approach to supporting quality improvement in health care.
The research team, under the direction of Chief Investigators Professorial Fellow Claire Johnson and Professor Angus Cook, is planning to establish an integrated information network to support GPs to provide best-practice management for the expanding regional numbers of patients with late-stage conditions and multi-morbidities.
This network will build directly on the clinic-based approaches that we developed in this project.
It will involve systematic collection of clinical outcomes from a GP sentinel network, assessment of clinical performance against evidence-based quality indicators and benchmarks, and regular feedback and improvement strategies tailored to general practice.
Quality indicators will cover key aspects of symptom relief, continuity of care, communication, care planning and decision-making.
The research team is currently engaging in discussions with different organisations, agencies and clinical teams to build ongoing collaborations.