School of Nursing, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.
Connected Palliative Care, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
J Health Organ Manag. 2020 May 25;ahead-of-print(ahead-of-print). doi: 10.1108/JHOM-07-2019-0218.
Following the development of a service that consisted of a "single point of contact" to coordinate end-of-life care (EoLC), including EoLC facilitators and an urgent response team, we aimed to explore whether the provision of coordinated EoLC would support patients being cared or dying in their preferred place and avoid unwanted hospital admissions.
DESIGN/METHODOLOGY/APPROACH: Using a realist evaluation approach, the authors examined "what worked for whom, how, in what circumstances and why". Multiple data were collected, including activity/performance indicators, observations of management meetings, documents, satisfaction survey and 30 interviews with service providers and users.
Advance care planning (ACP) increased through the first three years of the service (from 45% to 83%) and on average 74% of patients achieved preferred place of death. More than 70% of patients avoided an emergency or unplanned hospital admission in their last month of life. The mechanisms and context identified as driving forces of the service included: 7/7 single point of contact; coordinating services across providers; recruiting and developing the workforce; understanding and clarifying new roles; and managing expectations.
RESEARCH LIMITATIONS/IMPLICATIONS: This was a service evaluation and the outcomes are related to the specific context and mechanisms. However, findings can be transferable to similar settings.
"Single point of contact" services that offer coordinated EoLC can contribute in supporting people to be cared and die in their preferred place.
ORIGINALITY/VALUE: This paper provides an evaluation of a novel approach to EoLC and creates a set of hypotheses that could be further tested in similar services in the future.
在开发了一项包括临终关怀（EoLC）协调员和紧急反应团队的“单一联系点”服务之后，我们旨在探索提供协调的 EoLC 是否可以支持患者在其首选地点接受护理或死亡，并避免不必要的住院治疗。
设计/方法/方法：作者使用现实主义评估方法，研究了“对谁、如何、在什么情况下以及为什么有效”。收集了多种数据，包括活动/绩效指标、管理会议观察、文件、满意度调查以及与服务提供者和用户的 30 次访谈。
在服务的头三年中，预先护理计划（ACP）有所增加（从 45%增加到 83%），平均有 74%的患者实现了首选的死亡地点。在生命的最后一个月，超过 70%的患者避免了紧急或非计划的住院治疗。确定为服务驱动力的机制和背景包括：7/7 单一联系点；协调服务提供者之间的服务；招募和发展劳动力；理解和澄清新角色；以及管理期望。
研究局限性/影响：这是一项服务评估，结果与特定背景和机制有关。但是，发现可以转移到类似的环境中。
提供协调的 EoLC 的“单一联系点”服务可以帮助人们在其首选地点接受护理和死亡。
原创性/价值：本文对一种新的临终关怀方法进行了评估，并提出了一系列假设，这些假设可以在未来在类似的服务中进一步测试。
