Strengthening primary health care teams with palliative care leaders

INTERVENTION: Participating health centers are randomised to one of two groups. Randomization and concealment will be centralized, through a single coordinating center, using a computer‐generated block randomization in blocks of six. Control group: Health centers receive organisation and training as usual for the duration of the study. Intervention group: In participating health centers, palliative care leaders are appointed (nurses or doctors) and attend a 42 hour training course in palliative care based on “White Book” of PC training. The role of the leader is to train and promote PC, and to act as a consultant and liaison between the PC home‐based services and professionals in the primary health care services. Leaders will encourage health professional in their Health care centers to early identificate and assess case complexity of patients. Leaders in the early identification and assessment of case complexity of patients receiving referral to PC home‐based services will train primary health care doctors. Professionals will use The NECPAL CCOMS‐ICO© questionnaire, which identifies patients in need of palliative measures, especially non‐specific PC services, and the e IDC‐PAL tool, which is used for determining the complexity of PC that is needed for patients with advanced‐stage or terminal diseases. The intervention will be implemented 16 months from randomization. Although the intervention is carried out in the care of patients, patients themselves are now followed up. Outcome measures are collected for the last 90 days or last months of a patient's life by reviewing anonymised electronic patient records. CONDITION: Palliative care ; Not Applicable ; Palliative care PRIMARY OUTCOME: Current primary outcome measure as of 23/10/2018:; Early identification (=90 days before death) rate is assessed through electronic record review from patients who died between 18 to 24 months from randomization; ; Previous primary outcome measure:; Early identification (90 days before death) rate is assessed through electronic record review from patients who died between 18 to 24 months from randomization INCLUSION CRITERIA: 1. GPs and nurses 2. Working at primary health care centers located in the South Health District and the East Health District of Majorca SECONDARY OUTCOME: Current secondary outcome measures as of 23/10/2018:; 1. Case complexity is assessed through electronic record review from patients who died between 18 to 24 months from randomization; 2. Number of patients who die at home is assessed by review of the death certificates from patients who died between 18 to 24 months from randomization; 3. Total number of hospital admissions during the final month of life is assessed through electronic record review from patients who died between 18 to 24 months from randomization; 4. Total number of emergency room admissions during the final month of life is assessed through electronic record review from patients who died between 18 to 24 months from randomization; 5. Percentage of patients with any of the following “determinants of aggressive end‐of‐life care” during the final month of life is assessed through electronic record review from patients who died between 18 to 24 months from randomization; 5.1. Two or more admissions to the emergency room; 5.2. Two or more admissions to the hospital; 5.3. Two or more admissions to the ICU; 5.4. More than 14 days in the hospital; 6. Cost of resources during the final month of life (including emergency department visits, outpatient office visits, primary health care visits, inpatient hospital stays, and ICU admissions) will be calculated by standard cost‐per‐unit prices, obtained from the Balearic official regional bulletin from patients who died between 18 to 24 months from randomization; ; Previous secondary outcome measures:; 1. Case complexity is assessed through electronic record review from patients who died between 18 to 24 months from randomization; 2. Number of patients who die at home is assessed by review of the death certificates from patients who died between 18 to 24 months from randomization; 3. Total number of hospital admissions during the final month of life is assessed through electronic record review from patients who died between 18 to 24 months from randomization; 4. Total number of emergency room admissions during the final month of life is assessed through electronic record review from patients who died between 18 to 24 months from randomization; 5. Percentage of patients with any of the following “determinants of aggressive end‐of‐life care” during the final month of life is assessed through electronic record review from patients who died between 18 to 24 months from randomization; 5.1. One or more admission to the emergency room; 5.2. One or more admission to the hospital; 5.3. One or more admission to the ICU; 5.4. More than 14 days in the hospital; 6. Cost of resources during the final month of life (including emergency department visits, outpatient office visits, primary health care visits, inpatient hospital stays, and ICU admissions) will be calculated by standard cost‐per‐unit prices, obtained from the Balearic official regional bulletin from patients who died between 18 to 24 months from randomization;