Is Inpatient Hospice Care Clinically Effective? Using Phase of Illness to Evaluate Care Outcomes for Patients Admitted to a Specialist Palliative Care Unit in Ireland.

Abstract

<b><i>Background:</i></b> In health care, clinical effectiveness involves evaluating the degree to which clinical interventions achieve beneficial patient and caregiver outcomes. <b><i>Objective:</i></b> To evaluate the clinical effectiveness of care in a specialist palliative care unit (SPCU) in Ireland, including an analysis of the temporal relationship among admission, Phase of Illness and patient and family distress. <b><i>Design/Measurements:</i></b> A consecutive case series with prospectively collected admission data (<i>n</i> = 400). Using a casemix tool (Phase of Illness), pain, other symptoms, psychological and family distress, and performance status were documented on admission and then daily by medical staff. <b><i>Results:</i></b> Three hundred forty-two (85%) patients had complete data recorded on day 1. After admission, there were linear correlations between days since admission and progressive improvements in pain (Cramer's <i>V</i> = 0.131, <i>p</i> < 0.001), other symptoms (<i>V</i> = 0.206, <i>p</i> < 0.001), psychological distress (<i>V</i> = 0.101, <i>p</i> < 0.001), and family distress (<i>V</i> = 0.124, <i>p</i> < 0.001). Forty-three percent were in an unstable phase on admission. Nearly two thirds (60.7%) of these unstable patients converted to a stable phase within 48 hours of admission. Over the first 72 hours, 70.7% of unstable patients converted to a stable phase. There was also a significant correlation between phase stabilization and pain and symptom control (<i>p</i> = 0.007). Stable phase over the first 4 days and first 14 days was associated with significantly higher performance status. <b><i>Conclusion:</i></b> This study demonstrates the significant clinical effectiveness of SPCU admission across the different aspects of patient and family care.