Academic journal article Australian Health Review

The Australian Palliative Care Outcomes Collaboration (PCOC) - Measuring the Quality and Outcomes of Palliative Care on a Routine Basis

Academic journal article Australian Health Review

The Australian Palliative Care Outcomes Collaboration (PCOC) - Measuring the Quality and Outcomes of Palliative Care on a Routine Basis

Article excerpt

Governments across the developed world are increasingly grappling with how best to provide health care for people with life limiting illnesses1 and how best to measure the quality and outcomes ofthat care." Palliative care evolved as a speciality in Australia in the last three decades in response to the needs of people at the end of life and their families. Within health care, sub-specialisation was first offered by the Royal Australasian College of Physicians in 1987 and Australian Government funding of palliative care was included in the 1988 Australian Health Care Agreement.3 In October 2000, the Australian Government released the National Palliative Care Strategy: A National Framework for Palliative Care Service Development,4 an important milestone as it was a consensus document signed by all states and territories. Funding to support the Strategy was provided through the Australian Health Care Agreements 2003-2008.5 Ministerial agreement was reached to improve the provision of palliative care service and to report national minimum data to the Department of Health and Ageing and to develop and report on performance indicators.

Although still a relatively new field, palliative care is now an essential part of the Australian health system. National palliative care development is guided by the Palliative Care Intergovernmental Forum (PCIF), which consists of the Commonwealth and all states and territories, and the PCIF has recognised the need for nationally consistent reporting on palliative care service provision. Palliative Care Australia also has an important role and has produced consensus guidelines on palliative care service planning.6

As part of its Strategy, the Australian Government developed National Palliative Care Strategy Quality and Effectiveness Information Priorities 2003-2008,1 in which the processes to deliver on the quality initiatives in the Strategy were outlined. One part of this solution was to establish a Palliative Care Service Development Centre with the aim of improving the quality of care offered by palliative care services nationally. This virtual centre, the Palliative Care Outcomes Collaboration (PCOC), runs a voluntary, quality initiative that aims to assist participating palliative care services to measure the key aspects of the quality of care. PCOC brings together four research centres (three palliative care and one health services research) and is funded by the Australian Government Department of Health and Ageing.

The aim of this paper is to discuss the quality framework developed by PCOC and reflect on the evolution of measures and current variation in outcomes seen between participating services.

Method

PCOC commenced in June 2005 and is coordinated by the University of Wollongong's Centre for Health Service Development, which also provides a national training and analysis unit. Quality Improvement Facilitators are located in Adelaide, Brisbane, Melbourne, Perth and Wollongong and have responsibility for recruiting and training services and for working with them to optimise local processes for quality of care. The governance structure of PCOC comprises a Management Advisory Board and Scientific and Clinical Advisory Committee which meet regularly.

In order to achieve national consistency, PCOC developed a data-collection framework to ensure that the data collected were sufficient and useful in understanding quality at a patient, service and health system level. The PCOC information architecture is summarised in Fig. 1.

Three levels of data are collected. At the highest level is the patient and their carer or carers and various demographic and clinical patient information are collected at this level. At the next level is information on each 'episode of care' that the patient has. Episodes of care may occur in hospital or in the community and are built around where care is provided. Episode changes occur when the place of care changes. Finally, information about each 'phase of care' is collected, focussing on the phase of illness8'9 symptoms and functional status. …

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