Use of an automated prospective clinical surveillance tool to drive screening for unmet palliative needs among patients in the final year of life
We think implementing the mHOMR tool will increase the number of patients assessed for palliative needs and who receive palliative treatment such as pain management and palliative homecare. Across four hospitals in this project, up to 1,000 patients every year could receive better end-of-life care because of the mHOMR tool.
About the Project
A palliative approach to care can improve the quality of life of patients and families facing life-threatening illness by preventing and relieving suffering. Suffering may be caused by pain, nausea, anxiety and spiritual distress. To provide a palliative approach to care, physicians must first identify individuals who have life-threatening illnesses and unmet palliative needs.
People nearing the end-of-life often have unmet palliative needs. It can be hard for physicians to know when a person is close to death. Some tools exist, but these are difficult to use and not very accurate. Most physicians rely on their personal experience to make an educated guess about when their patient may be nearing the end-of-life. This method is unreliable and inaccurate for many illnesses. To address this problem, we created an electronic tool (mHOMR tool) that uses electronic medical information to automatically identify people who are likely nearing the end-of-life and notifies their treating team to assess for unmet palliative needs.
Implementing the mHOMR tool in hospitals will help physicians identify patients with unmet palliative needs and improve access to a palliative approach to care near the end-of-life.
James Downar, MDCM, MHSc – Ottawa Hospital Research Institute
Melanie Barwick, PhD – Hospital for Sick Children
Martin Chasen, MD – William Osler Health System
Leonie Herx, MD, PhD – Kingston Health Sciences Centre
Ahmed Jakda, MD, MBA – Ontario Palliative Care Network
Daniel Kobewka, MD – The Ottawa Hospital
Kwadwo Kyeremanteng, MD – Montfort Hospital
Peter Tanuseputro, MD, PhD – Bruyere Continuing Care
Peter Varga, BScN, MHSc – Headwaters Health Care Centre
Pete Wegier, PhD – Sinai Health System
Valerie Gratton, MD – Montfort Hospital
Paul Hebert, MD – Centre Hospitalier de l’Université de Montréal
Danielle Kain, MD – Kingston Health Sciences Centre
Peter Lawlor, MD, PhD – Bruyere Continuing Care
Mercedes Rodriguez, MD – Headwaters Health Care Centre
Mary Scott, BSc – Bruyere Continuing Care
Melissa Touw, MSc – Kingston Health Sciences Centre
Lori van Manen, BNSc, MSc – Kingston Health Sciences Centre
Colleen Webber, PhD – Bruyere Continuing Care
Lee Fairclough – Health Quality Ontario
Elan Graves – Canadian Foundation for Healthcare Improvement (CFHI)
Lewis Park – Headwaters Health Care Centre
Mary Wheelwright, BSc, MBA – Headwaters Health Care Centre
Project Contact: Dr. James Downar – firstname.lastname@example.org
Key words: palliative care; palliative medicine; end-of-life; quality of life; clinical surveillance; early identification; clinical trial; intervention-implementation research; implementation science
To see if implementing the mHOMR tool improves identification of patients’ palliative needs and leads to better care at the end-of-life.
We will implement the mHOMR tool in four Ontario hospitals. To measure the effect of the tool we will check hospital records and follow patients over time to see if their palliative needs were identified and what palliative care they subsequently received in the hospital and community.