Effects of an Integrated Palliative Care Pathway: More Proactive GPs, Well Timed, and Less Acute Care: A Clustered, Partially Controlled Before-After Study

AbstractObjectives This study presents the design of an integrated, proactive palliative care pathway covering full cycle and evaluates its effects using 3 types outcomes: (1) physician-reported outcomes, (2) outcomes reported by family, (3) (utilization of) health outcomes. Design A clustered, partially controlled before-after with a multidisciplinary integrated as main intervention. Setting Participants after assessment in hospital departments oncology, geriatrics, 13 primary facilities, terminally ill patients were proactively included into pathway. Patients' relatives patients' general practitioners (GPs) participated before/after survey interviews focus groups. Intervention multidisciplinary, encompassing (among others) early identification phase, consultation coordination, continuous monitoring Measures Measures GP questionnaire: perceived quality care; questionnaires family members: FAMCARE, QOD-LTC, EDIZ; utilization care: consultations, intensive care, communication, home visits, consultations visits during weekends out-of-office-hours, ambulance, admission to hospital; outpatient ward day emergency room inpatient (radio) diagnostics, surgical procedures, other therapeutic activities, unit activities; pharmaceutical utilization. Results GPs that die more often at their preferred place death, they now act toward patients. Relatives included, deceased clinically relevant improved dying, timely care. Patients received (intensive) less unexpected out-of-office hours, form Conclusions Implications An improves variety clinical important patients, families, physicians, system. The integration pathways, is therefore desirable future development.