Life In The Slower Lane

Here is the PICO analysis for the sixth uploaded article:

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✅ PICO Analysis

Full Article Title:

Avoiding costly hospitalisation at end of life: findings from a specialist palliative care pilot in residential care for older adults

Type of Study:

Quasi-experimental design with matched historical controls

Journal and Year:

BMJ Supportive & Palliative Care (2018); 8:102–109

DOI: 10.1136/bmjspcare-2015-001071

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P – Population

• Setting: Four residential aged care facilities (RACFs) in Canberra, Australia
• Participants:
  • 104 residents in the intervention group (including those discussed in needs rounds, referred urgently to specialist palliative care (SPC), or who died during the study period)
  • 173 matched historical controls (decedents from the 3 years prior to the intervention)
• Characteristics:
  • Mean age: 89 years (intervention group) vs 86 years (control group)
  • Common diagnoses: dementia, cardiac failure
  • High comorbidity burden (Charlson score: 6.3 vs 5.0, p < 0.01) 

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I – Intervention

• Type:
  • Specialist Palliative Care (SPC) Nurse Practitioner-led “Needs Rounds” model
• Description:
  • Monthly structured, case-based multidisciplinary meetings at each RACF, led by an SPC Nurse Practitioner
  • Focus on identifying residents with a prognosis of ≤6 months or high complexity needs
  • Involved proactive planning, clinical mentoring, goals of care discussions, and advance care planning (ACP)
  • Supplemented by direct SPC access, prescribing, and follow-up care coordination
  • Education embedded into case-based discussions with facility staff

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C – Comparison

• Control Group:
  • Historical cohort of residents who died prior to the intervention, receiving “usual care” SPC support via ad hoc GP referral
  • No systematic needs rounds or proactive case identification

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O – Outcomes

Primary Outcomes:

1. Hospitalisation Outcomes:
   • No significant change in hospital admission rates (average 0.8 vs 0.6, p = 0.11)
   • Significant reduction in length of hospital stays:
     • All decedents: 2.17-day reduction (p = 0.02)
     • Needs Round subgroup: 3.22-day reduction (p < 0.01) = 67% reduction in admitted days 
2. Place of Death:
   • 76% had documented Preferred Place of Death (PPoD)
   • 100% of residents with PPoD died in their preferred location
   • 96% of those nominated residential aged care as PPoD
   • Hospital deaths reduced by 10% in the needs round subgroup (p = 0.04)
3. Cost Savings (estimates):
   • $A115,539 saved across 58 decedents (based on $A918 per hospital bed day)
   • Approx. $A1,992 saved per decedent (increased to $A2,955 in needs round subgroup)

Outcome Classification:

• Person-centred outcomes: Goal-concordant care, avoidance of unwanted transfers, increased rates of in-place death
• Process outcomes: Better documentation of PPoD, structured ACP, improved staff knowledge
• System outcomes: Reduced hospital bed days and associated costs 

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