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P22 Improving the comprehensive care of people with advanced chronic diseases in acute hospitals
  1. Rosa Mertnoff1,
  2. Cecilia Vindrola Padros2,
  3. Eugenia Brague1,
  4. Walter Cattaneo3,
  5. Lucila Falcone1,
  6. Maria Belen Ayala Torales4,
  7. Mariangeles Pirchi5
  1. 1PALIATIVA NGO, Buenos Aires, Argentina
  2. 2Department of Applied Health Research, UCL, London, UK
  3. 3Hospital Central Dr. Ramón Madariaga, Posadas, Argentina
  4. 4Hospital Dr. J.C Perrando, Resistencia Chaco, Argentina
  5. 5Hospital José Ramón Vidal, Corrientes, Argentina

Abstract

Background One of the most relevant challenges of healthcare systems is to provide high quality and cost-effective responses in progressive advanced chronic conditions with limited life prognosis and palliative care needs (PACC). These populations represent 75% of the mortality in middle-high income countries, a prevalence of 1.5% of general population, and 35%–45% of hospital admissions. Over the last 10 years, a new perspective of palliative care has emerged, identifying needs earlier and addressing them across all stages of patient´s pathway. Our study is informed by this perspective and based on the implementation of a screening instrument identifying needs of PACC 48 hours after their hospital admission.

Objectives

  1. Determine prevalence, clinical characteristics, and needs of PACC in acute care hospitals;

  2. Identify barriers, difficulties, challenges and develop proposals to improve their attention;

  3. Establish survival rates relating it to each illness trajectory (cancer, organ failure, frailty, and dementia).

Methods Quantitative Phase:

Observational, multicenter, cross-sectional descriptive study to determine prevalence and clinical characteristics of PACC in 3 acute hospitals (AH) of the Northeast of Argentina (NEA) using NECPAL-CCOMS-ICO® instrument. It will involve a longitudinal analysis of a cohort of recruited patients for 1.2 years.

Qualitative Phase:

Each hospital will undergo a self-assessment survey exploring their current care delivery models and potential barriers they might face in delivering continuous care to PACC. Focus groups will be carried out with a sample of healthcare professionals exploring these barriers in greater detail.

Expected results

  • Prevalence of PACC in AH

  • Characteristics of PACC in AH of the NEA

  • Survival of PACC identified at 1.2 years and predictive model

  • Definition of improvement areas to elaborate an integrated assistance proposal, including training, quality standards and organizational changes adapting the use of hospital resources to implement a more efficient model of care delivery.

This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2019-QHRN.57

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