A proposed systems approach to the evaluation of integrated palliative care
1 Department of Clinical Epidemiology and Biostatistics, McMaster University, Juravinski Cancer Centre, 699 Concession St. Rm 4-203, Hamilton, ON L8V 5C2 Canada
2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Division of Palliative Care, Department of Family Medicine, McMaster University, St. Joseph's Health System Research Network, 105 Main Street East, Level P1, Hamilton, ON L8N 1G6 Canada
3 Department of Family and Community Medicine, University of Toronto, 263 McCaul Street, Room 325, Toronto, ON M5T 1W7 Canada
4 School of Nursing, McMaster University, Department of Health, Aging and Society, McMaster University, Health Sciences Centre, 1200 Main St. W., Room 3N28G, Hamilton ON L8N 3Z5 Canada
5 Division of Palliative Care, Department of Family Medicine, McMaster University, Health Sciences Centre, 1200 Main St. W., Room 4X22, Hamilton ON L8N 3Z5 Canada
BMC Palliative Care 2010, 9:8 doi:10.1186/1472-684X-9-8Published: 10 May 2010
There is increasing global interest in regional palliative care networks (PCN) to integrate care, creating systems that are more cost-effective and responsive in multi-agency settings. Networks are particularly relevant where different professional skill sets are required to serve the broad spectrum of end-of-life needs. We propose a comprehensive framework for evaluating PCNs, focusing on the nature and extent of inter-professional collaboration, community readiness, and client-centred care.
In the absence of an overarching structure for examining PCNs, a framework was developed based on previous models of health system evaluation, explicit theory, and the research literature relevant to PCN functioning. This research evidence was used to substantiate the choice of model factors.
The proposed framework takes a systems approach with system structure, process of care, and patient outcomes levels of consideration. Each factor represented makes an independent contribution to the description and assessment of the network.
Realizing palliative patients' needs for complex packages of treatment and social support, in a seamless, cost-effective manner, are major drivers of the impetus for network-integrated care. The framework proposed is a first step to guide evaluation to inform the development of appropriate strategies to further promote collaboration within the PCN and, ultimately, optimal palliative care that meets patients' needs and expectations.