O-22 HOLISTIC (hospice-led innovations study to improve care)

Background A current concern is the number of people dying in hospital who have no medical need, or wish, to be there (Marie Curie Cancer Care, 2012). 72% of people would prefer to die at home (ComRes, 2014), yet just 25% do so, with 50% dying in hospital (Gomes, Calanzani, Higginson, 2011). Instinctively, hospice-led initiatives play an important role in minimising inappropriate hospital usage at the end of life, but there is a lack of robust data. Aim To establish the impact of different hospice led innovations on a) reducing the number of hospital bed days during the last 90 days of life, b) place of death and other secondary outcome measures: the number of emergency and inpatient admissions and discharges to a hospice in the last 90 days of life. Method Mixed methods study with a quantitative quasi-experimental longitudinal design employing a ‘difference of difference’ analysis of HES data to assess the impact on hospital utilisation in the last 90 days of life. Any encountered differences are compared to control cohorts. Stakeholders were qualitatively interviewed through open-ended, semi-structured and structured interviews followed by narrative, framework and content analysis respectively. Results Quantitative: ongoing, however, we anticipate data showing a reduction in the number of hospital beds days, in the last 90 days of life, within the locality of the intervention hospice. Qualitative: interviewed 188 people, including 24 patients and carers, across 27 interventions at 25 sites providing 31 recurrent topics of which the five most relatively frequent were the process of development, collaboration, the intervention group, staff roles and professional culture. Conclusions Qualitative evaluation of these innovations shows benefit to the patient experience and factors critical to success and replicability. Quantitative data will show the impact on NHS resources, and together the findings will enable better evidence-based commissioning, supporting service redesign at a local level. Final report due Sept. 2018.