Testing a case-mix classification in palliative care
Research type
Research Study
Full title
C-CHANGE Workstream 4: Testing a case-mix classification in palliative care (cohort study)
IRAS ID
204926
Contact name
Fliss E M Murtagh
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
2 years, months, days
Research summary
In England, hospice movement has provided a model of good care for those with advanced progressive disease. However, there are marked inequities in care provision. Elderly people or those with non-cancer conditions, for instance, are less likely to receive palliative care. There are also major geographical variations in NHS provision often resulting in a mismatch between palliative care needs of patients/families, resources provided to meet those needs, and health outcomes achieved.
This study is Workstream 4 of a five year NIHR funded C-CHANGE project (RP-PG-1210-12015). Workstream 4 includes adults (≥18 years) receiving specialist palliative care, and extends across both cancer and non-cancer conditions, and across inpatient, community and outpatient settings. It is a cohort study following participants for up to 24 months, to test a case-mix classification longitudinally through transitions between settings. This is underpinned by previous workstreams which developed/tested the case-mix classification in discrete episodes.
Patient participants and family carers will provide data on symptoms/concerns, whether these are addressed, demographics/social variables, and service use. A post bereavement survey will be posted to family carers where appropriate, to identify symptoms/concerns immediately prior to death, and support needs after death.
Clinicians will collect the patients' demographic/clinical data, and potential case-mix variables (e.g., phase of illness, functional status and problem severity) alongside information on patient-level resource use. These will be linked to patients' data, encrypted and transferred to the central database for analysis.
This study will lead to patient benefit through improved matching of resources to needs at patient-level and will better enable the NHS to deliver high quality, patient-centred palliative care. A case-mix classification categorises people by complexity of needs. The results will determine whether the case-mix classification can effectively classify patients in terms of needs and resource use, and provide framework for better understanding outcomes, and potential funding models for palliative care.
REC name
London - Bromley Research Ethics Committee
REC reference
16/LO/1021
Date of REC Opinion
21 Jun 2016
REC opinion
Favourable Opinion