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Wong SY, Teo YN, Wo YJ, Lim CW, Lai YF. Distilling lessons from home hospital implementation: a narrative scoping review. Singapore Med J 2024:00077293-990000000-00093. [PMID: 38363647 DOI: 10.4103/singaporemedj.smj-2020-478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/16/2022] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Multiple Cochrane Reviews have demonstrated 'hospital at home' (HaH) as a promising healthcare model to be explored, with benefits such as higher care quality, reduced readmissions, shorter lengths of stay, lower cost and greater patient satisfaction. While there have been many reviews focusing on the quantitative clinical outcomes of HaH, there is generally a lack of collation of qualitative insights from stakeholders and lessons learnt from past HaH implementation. METHODS We performed a systematic literature search on four databases and included 17 papers involving the provision of acute and/or subacute care by healthcare professionals in patients' homes. Review characteristics and relevant outcomes were extracted from the reported findings and tables in the reviews, and these included stakeholder attitudes and factors contributing to the success of HaH implementation. RESULTS Factors relating to patients and caregivers included home setup, preference for care and death settings, and support for caregiver. Factors involving the healthcare professionals and intervention included a multidisciplinary care team, accessibility to emergency care and support, training of providers and patients, adequate manpower allocation, robust eligibility and referral criteria, sufficient awareness of the HaH referral pathway, communication and medication management. CONCLUSION HaH presents a promising alternative care model, and many of the success factors identified, including the strong push for multidisciplinary single care teams, existing frameworks for data sharing and strong community network, are already present today. As such, Singapore appears to be well positioned to adopt a new care model like HaH.
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Affiliation(s)
- Shi Yin Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Neng Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yu Jun Wo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cher Wee Lim
- Office for Healthcare Transformation, Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yi Feng Lai
- Office for Healthcare Transformation, Ministry of Health, Singapore
- School of Public Health, University of Illinois at Chicago, USA
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
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Myint AT, Tiraphat S, Jayasvasti I, Hong SA, Kasemsup V. Factors Influencing the Willingness of Palliative Care Utilization among the Older Population with Active Cancers: A Case Study in Mandalay, Myanmar. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157887. [PMID: 34360179 PMCID: PMC8345377 DOI: 10.3390/ijerph18157887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 01/08/2023]
Abstract
Palliative care is an effective, multidisciplinary healthcare service to alleviate severe illness patients from physical, psychological, and spiritual pain. However, global palliative care has been underutilized, especially in developing countries. This cross-sectional survey aimed to examine the factors associated with older cancer patients’ willingness to utilize palliative care services in Myanmar. The final sample was composed of 141 older adults, 50-years of age and above who suffered from cancers at any stage. Simple random sampling was applied to choose the participants by purposively selecting three oncology clinics with daycare chemotherapy centers in Mandalay. We collected data using structured questionnaires composed of five sections. The sections include the participant’s socio-economic information, disease status, knowledge of palliative care, psychosocial and spiritual need, practical need, and willingness to utilize palliative care services. The study found that approximately 85% of older cancer patients are willing to receive palliative care services. The significant predictors of willingness to utilize palliative care services include place of living, better palliative care knowledge, more need for spiritual and psychosocial support, and practical support. This study can guide health policymakers in increasing the rate of palliative care utilization. The suggested policies include developing community-level palliative care services in Myanmar, especially in rural areas, promoting palliative care knowledge, applying appropriate religious and spiritual traditions at palliative treatment, and developing suitable medicines for the critically ill.
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Affiliation(s)
- Aye Tinzar Myint
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand; (A.T.M.); (S.A.H.); (V.K.)
| | - Sariyamon Tiraphat
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand; (A.T.M.); (S.A.H.); (V.K.)
- Correspondence: ; Tel.: +66-2-441-9040-3 (ext. 54); Fax: +66-2-441-9044
| | - Isareethika Jayasvasti
- Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand;
| | - Seo Ah Hong
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand; (A.T.M.); (S.A.H.); (V.K.)
| | - Vijj Kasemsup
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand; (A.T.M.); (S.A.H.); (V.K.)
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Lin Y, Long-Sutehall T, Myall M. Transferring home to die from critical care units: A scoping review of international practices. J Crit Care 2021; 65:205-215. [PMID: 34243069 DOI: 10.1016/j.jcrc.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify and characterise the international practices of transferring a dying patient home to die from critical care units. MATERIALS AND METHODS A systematic scoping review following the Joanne Briggs Institute methodology was applied searching fifteen data sources to identify papers published in English and Chinese from 1970 to 2019. RESULTS Of the 28 papers meeting eligibility criteria 19 were published in the West and seven in China. The number of patients being transferred home to die was larger in China (74/184-96/159) than in the West (1-7). Clinical characteristics of patients transferred included: consciousness, with or without intubation and ventilation, and clinical stability. Reported key barriers to transfer included: Lack of evidence guiding transfer practice, the CCU environment and culture, Practical and logistical factors and Family members expectations and reactions. Key facilitators of transfer were reported as: Engagement with the multidisciplinary team and Personal patient and family wishes. CONCLUSIONS Transferring patients home to die from critical care is a complex practice varying significantly across countries. Further research to address current knowledge gaps is important to inform policy and practice.
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Affiliation(s)
- Yanxia Lin
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK.
| | - Tracy Long-Sutehall
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK
| | - Michelle Myall
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK
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Fringer A, Stängle S, Bischofberger I, Büche D, Praxmarer R, Ch Ott S, Schnepp W. Experiences of relatives with outpatient palliative care: a cross-sectional study. Int J Palliat Nurs 2021; 26:230-237. [PMID: 32584687 DOI: 10.12968/ijpn.2020.26.5.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The authors aimed to evaluate the experiences of the relatives of dying people, both in regard to benefits and special needs, when supported by a mobile palliative care bridging service (MPCBS), which exists to enable dying people to stay at home and to support patients' relatives. DESIGN A cross-sectional survey. METHODS A standardised survey was performed, asking 106 relatives of dying people about their experiences with the MPCBS (response rate=47.3%). Descriptive statistics were analysed using SPSS 23. FINDINGS Many relatives (62.5%) reported that their dying relations when discharged from a facility to stay at home were not symptom-free. The MPCBS helped relatives maintain home care, and this was reported to be helpful. Support provided by the MPCBS made it easier for 77.6% of relatives to adjust care as soon as situations changed, and helped ensure that symptoms could be better controlled, at least for 68.2% of relatives. Younger relatives felt more encouraged by the MPCBS to care for their relatives dying at home.
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Affiliation(s)
- André Fringer
- Professor for Family-Centered Care; Co-Head MSc Nursing and Co-Head Research Unit Nursing, ZHAW Zurich University of Applied Sciences, School of Health Professions, Institute of Nursing, Winterthur, Switzerland and Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, Germany
| | - Sabrina Stängle
- Research Associate, ZHAW Zurich University of Applied Sciences, School of Health Professions, Institute of Nursing, Winterthur, Switzerland and Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, Germany
| | - Iren Bischofberger
- Professor for Applied Research and Clinical Excellence in Nursing, Kalaidos University of Applied Sciences, Department of Health Science, Zurich, Switzerland
| | - Daniel Büche
- Head Physician Palliative Care Centre, Cantonal Hospital St.Gallen, St. Gallen, Switzerland
| | - Renate Praxmarer
- Co-Head of Palliative Bridge Service, Cancer League of Eastern Switzerland, Bern, Switzerland
| | - Stefan Ch Ott
- Professor of Economics, FHS St.Gallen University of Applied Sciences, Department of Economics, St.Gallen, Switzerland
| | - Wilfried Schnepp
- Head of the Department for Family-Oriented and Community Care, Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, Germany
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Human Immunodeficiency Virus in Southern and East Africa the Pandemic and Interface with Rehabilitation. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Krongyuth P, Silpasuwan P, Viwatwongkasem C, Campbell C. Needs of patient with advanced stages of cancer in a Thai community. JOURNAL OF HEALTH RESEARCH 2018. [DOI: 10.1108/jhr-08-2018-040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The purpose of this paper is to explore the needs of people with cancer in advanced stages and to analyze factors that influence them.
Design/methodology/approach
A concurrent mixed-method design was used. Descriptive design was conducted in Ubon Ratchathani Province, Thailand. Data were collected from a convenience sample of patients with advanced cancer of any tissue or organ. Questionnaires were completed by 110 patients aged 60 years and above (response rate 110/130=84.6 percent). In-depth interviews were conducted with a total of eight patients. Content analysis of semi-structured interviews of a sub-sample was subsequently performed to better understand the real needs of patients with advanced stages of cancer at home setting.
Findings
The majority (77.5 percent) reported a preference to spend their final days at home. The four most common palliative care needs were more information about disease and medical treatment (98.2 percent), more treatment for pain (97.3 percent), health education for family caregivers (95.5 percent) and health volunteers visit at home (95.5 percent). Content analysis of the qualitative data suggested that patient needs health care providers to deliver open communication, pain management and provide psychosocial supports.
Originality/value
The result showed that patients-related variables are associated with the palliative care needs in patients with advanced stages of cancer. Communication skills and pain management are the key components to support the need for palliative care at home and to benefit the quality of life in terminally ill patients.
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Tryselius K, Benzein E, Persson C. Ideas of home in palliative care research: A concept analysis. Nurs Forum 2018; 53:383-391. [PMID: 29687445 DOI: 10.1111/nuf.12257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To explore the concept of home and its' expressed spatialities in current palliative care research. BACKGROUND Home is a central environment for living, caring, and dying. However, pure investigations of the sets of ideas linked to the concept seemed missing. Although identified as an important location, spatial perspectives expressed through the concept of home appeared unexplored. DESIGN Rodgers' evolutionary concept analysis. DATA SOURCES Scientific articles published between January 2009 and September 2015. REVIEW METHODS Rodgers' evolutionary concept analysis. Resulting attributes were explored from two geographically informed spatial perspectives. RESULTS As main results, six attributes were identified and explored: Home as actor-capable of acting; emotional environment-something people have feelings for; place-a part of personal identity and a location; space-complex and relational spatial connections and a site for care; setting-passive background and absolute space; becoming-a fluid spatiality constantly folded. Examples of attributes and suggestions for further concept development were identified. CONCLUSIONS The concept reflects various sets of ideas as well as expressing both relational and absolute perspectives of space. The most challenging for nursing research and practice seems to be investigation, operationalization, and testing the implementation of sets of ideas reflecting a relational thinking of space.
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Affiliation(s)
- Kristina Tryselius
- Department of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Eva Benzein
- Department of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Carina Persson
- Department of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
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STAKEHOLDER INVOLVEMENT THROUGHOUT HEALTH TECHNOLOGY ASSESSMENT: AN EXAMPLE FROM PALLIATIVE CARE. Int J Technol Assess Health Care 2017; 33:552-561. [DOI: 10.1017/s026646231700068x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives: Internationally, funders require stakeholder involvement throughout health technology assessment (HTA). We report successes, challenges, and lessons learned from extensive stakeholder involvement throughout a palliative care case study that demonstrates new concepts and methods for HTA.Methods: A 5-step “INTEGRATE-HTA Model” developed within the INTEGRATE-HTA project guided the case study. Using convenience or purposive sampling or directly / indirectly identifying and approaching individuals / groups, stakeholders participated in qualitative research or consultation meetings. During scoping, 132 stakeholders, aged ≥ 18 years in seven countries (England, Italy, Germany, The Netherlands, Norway, Lithuania, and Poland), highlighted key issues in palliative care that assisted identification of the intervention and comparator. Subsequently stakeholders in four countries participated in face–face, telephone and / or video Skype meetings to inform evidence collection and / or review assessment results. An applicability assessment to identify contextual and implementation barriers and enablers for the case study findings involved twelve professionals in the three countries. Finally, thirteen stakeholders participated in a mock decision-making meeting in England.Results: Views about the best methods of stakeholder involvement vary internationally. Stakeholders make valuable contributions in all stages of HTA; assisting decision making about interventions, comparators, research questions; providing evidence and insights into findings, gap analyses and applicability assessments. Key challenges exist regarding inclusivity, time, and resource use.Conclusion: Stakeholder involvement is feasible and worthwhile throughout HTA, sometimes providing unique insights. Various methods can be used to include stakeholders, although challenges exist. Recognition of stakeholder expertise and further guidance about stakeholder consultation methods is needed.
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A positive risk approach when clients choose to live at risk: a palliative case discussion. Curr Opin Support Palliat Care 2016; 10:214-20. [PMID: 27359077 DOI: 10.1097/spc.0000000000000223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The article discusses recent approaches in the literature about clients who chose to live at risk in their homes. It argues for a positive risk-based approach and a tool to help manage risk in the home, and applies these to a hypothetical end-of-life scenario. RECENT FINDINGS Historically, safety plans to consider risk management involved a culture of risk aversion supported by sometimes paternalistic motives intended to protect vulnerable clients. New findings in the literature engage in a process that respects the ethical principles underlying harm reduction philosophies. The literature also argues for a perspective that moves away from viewing risk as only harmful, to one that supports a positive understanding of risk as part of a client's informed choice. SUMMARY A risk support management plan, based on a positive approach, can provide a way to both support a client's choice to live at risk, anticipate for expected complications, and inform the creation of a contingency plan to address concerns as they may arise. The added value of a structured approach like the one proposed here for risk support management plans is that it provides adequate due diligence and informed decision-making when planning for risk-taking in complex situations.
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Baird-Bower D, Roach J, Andrews M, Onslow F, Curnin E. Help is just a phone call away: after-hours support for palliative care patients wishing to die at home. Int J Palliat Nurs 2016; 22:286-91. [DOI: 10.12968/ijpn.2016.22.6.286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Julie Roach
- Research Coordinator at The District Nurses hospice@HOME, Moonah, Tasmania, Australia
| | - Morven Andrews
- Research Co-ordinator at The District Nurses hospice@HOME, Moonah, Tasmania, Australia
| | - Fiona Onslow
- Director of State Operations at The District Nurses hospice@HOME, Moonah, Tasmania, Australia
| | - Emma Curnin
- Clinical Project Manager at The District Nurses hospice@HOME, Moonah, Tasmania, Australia
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Chiang JK, Kao YH, Lai NS. The Impact of Hospice Care on Survival and Healthcare Costs for Patients with Lung Cancer: A National Longitudinal Population-Based Study in Taiwan. PLoS One 2015; 10:e0138773. [PMID: 26406871 PMCID: PMC4583292 DOI: 10.1371/journal.pone.0138773] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 09/02/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The healthcare costs of cancer care are highest in the last month of life. The effect of hospice care on end-of-life (EOL) healthcare costs is not clearly understood. PURPOSE The purpose of this study was to evaluate the effect of hospice care on survival and healthcare costs for lung cancer patients in their final month of life. METHODS We adopted Taiwan's National Health Insurance Research Claims Database to analyze data for 3399 adult lung cancer patients who died in 1997-2011. A logistic regression analysis was performed to determine the predictors of high healthcare cost, defined as costs falling above the 90th percentile. Patients who received hospice cares were assigned to a hospice (H) group and those who did not were assigned to a non-hospice (non-H) group. RESULTS The patients in the H group had a longer mean (median) survival time than those in the non-H group did (1.40 ± 1.61 y (0.86) vs. 1.10 ± 1.47 (0.61), p<0.001). The non-H group had a lower mean healthcare cost than the H group (US $1,821 ± 2,441 vs. US $1,839 ± 1,638, p<0.001). And, there were a total of 340 patients (10%) with the healthcare costs exceeding the 90th percentile (US $4,721) as the cutoff value of high cost. The non-H group had a higher risk of high cost than the H group because many more cases in the non-H group had lower costs. Moreover, the risk of high health care costs were predicted for patients who did not receive hospice care (odds ratio [OR]: 3.68, 95% confidence interval [CI]: 2.44-5.79), received chemotherapy (OR: 1.51, 95% CI: 1.18-1.96) and intubation (OR: 2.63, 95% CI: 1.64-4.16), and those who had more emergency department visits (OR: 1.78, 95% CI: 1.24-2.52), longer hospital admission in days (OR: 1.08, 95% CI: 1.07-1.09), and received radiotherapy (OR: 1.33, 95% CI: 1.00-1.78). Lower risks of high health care costs were observed in patients with low socioeconomic status (OR: 0.58, 95% CI: 0.40-0.83), or previous employment (OR: 0.66, 95% CI: 0.47-0.92). After propensity-score matching, the patients of the non-H group had a higher mean cost and a higher risk of high cost. Similar results were obtained from logistic regression analysis in propensity score-matched patients. CONCLUSIONS The survival of the hospice group was longer than non-H group, and patients in the non-H group were 3.74 times more likely to have high healthcare costs at EOL. The positive predictors for high health care costs were patients who did not receive hospice care, who received chemotherapy and intubation, who had more emergency department visits and longer hospital admission, and who received radiotherapy. Negative predictors were patients who had a low socioeconomic status or previous employment. The issue of how to reduce the high health care costs for patients with lung cancer in the last month of life is a challenge for policy makers and health care providers.
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Affiliation(s)
- Jui-Kun Chiang
- Department of Family Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan
| | - Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital, Tainan, Taiwan
| | - Ning-Sheng Lai
- Department of Allergy, Immunology and Rheumatology, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
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Applying research into practice: a guide to determine the next palliative home care nurse visit. ACTA ACUST UNITED AC 2015; 32:88-95; quiz 95-7. [PMID: 24492266 DOI: 10.1097/nhh.0000000000000018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Beyond their own family caregivers, home healthcare nurses play a pivotal role in caring for those dying at home. However, deciding the timing of the next visit for these patients and their families is not straightforward. The Palliative Care: Determining Next Home Care Nurse Visit decision guide supports clinicians in their decision-making process of planning visits to most effectively meet the needs and goals of patients and families during the final months of life.
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Masella C, Garavaglia G, Borghi G, Castelli A, Radaelli G, Peruselli C. Implementation of a Hospital-Based Home Palliative Care at regional level: a quantitative study of the Ospedalizzazione Domiciliare Cure Palliative Oncologiche program in Lombardy. Palliat Med 2015; 29:241-8. [PMID: 25524959 DOI: 10.1177/0269216314558156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Home Palliative Care services can overcome trends of institutionalized dying and support higher rates of death at home. Home Palliative Care services rarely scale-up into regional health planning. This generates unwarranted variability in service provision and outcomes across patients. Lombardy Region sponsored a Hospital-Based Home Palliative Care program, which implemented a common service to oncological patients in the territory, with the purpose to align hospitals toward a target of 65% deaths at home. AIM Our work assesses service characteristics and outcomes achieved by the regional program from 2009 to 2011. DESIGN AND SETTING Descriptive analysis from an institutional database of service characteristics, regional expenditure, and outcomes (temporary hospitalization and patient discharge) representing 11,841 patients served by 24 providers in the period 2009-2011. RESULTS Targets of 65% deaths at home were achieved across the Region, with temporary re-hospitalization below 4.4%. The average pathway length stood above 1 month; intensity of care stood above ministerial and regional standards, with most home visits performed by nurses and physicians. CONCLUSIONS The implementation of the regional program revealed three strengths (prompt identification and enrollment of eligible patients, and quantity of home visits) and two weaknesses (limited enrollment from general practitioners and multi-disciplinarity). This highlights opportunities for policy-makers to invest on regional protocols of Hospital-Based Home Palliative Care to reduce trends of institutionalized dying and align providers to homogeneous results.
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Affiliation(s)
- Cristina Masella
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Giulia Garavaglia
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | | | | | - Giovanni Radaelli
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
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