Development and validation of a casemix classification to predict costs of specialist palliative care provision across inpatient hospice, hospital and community settings in the UK: a study protocol

Abstract

IntroductionProvision of palliative care is inequitable with wide variations across conditions and settings in the UK. Lack of a standard way to classify by case complexity is one of the principle obstacles to addressing this. We aim to develop and validate a casemix classification to support the prediction of costs of specialist palliative care provision.Methods and analysisPhase I: A cohort study to determine the variables and potential classes to be included in a casemix classification. Data are collected from clinicians in palliative care services across inpatient hospice, hospital and community settings on: patient demographics, potential complexity/casemix criteria and patient-level resource use. Cost predictors are derived using multivariate regression and then incorporated into a classification using classification and regression trees. Internal validation will be conducted by bootstrapping to quantify any optimism in the predictive performance (calibration and discrimination) of the developed classification. Phase II: A mixed-methods cohort study across settings for external validation of the classification developed in phase I. Patient and family caregiver data will be collected longitudinally on demographics, potential complexity/casemix criteria and patient-level resource use. This will be triangulated with data collected from clinicians on potential complexity/casemix criteria and patient-level resource use, and with qualitative interviews with patients and caregivers about care provision across difference settings. The classification will be refined on the basis of its performance in the validation data set.Ethics and disseminationThe study has been approved by the National Health Service Health Research Authority Research Ethics Committee. The results are expected to be disseminated in 2018 through papers for publication in major palliative care journals; policy briefs for clinicians, commissioning leads and policy makers; and lay summaries for patients and public.Trial registration numberISRCTN90752212.

A pilot study on patient-related costs and factors associated with the cost of specialist palliative care in the hospital: first steps towards a patient classification system in Germany

“…In light of evidence that primary diagnoses may not be a good predictor of resource use for palliative care, the Australian classification for palliative care, which was developed as part of a broader classification covering sub-acute and non-acute care, took into account relevant cost drivers such as phase of illness and functional status [ 10 , 11 ]. Similar efforts are currently also undertaken in England [ 8 , 12 ].…”

A systematic review of classifications systems to determine complexity of patient care needs in palliative care

“…34 – 37 Additionally, it should be noted that there are complexity classification systems in development, identified through two protocols. 38 , 39 …”

“…[34][35][36][37] Additionally, it should be noted that there are complexity classification systems in development, identified through two protocols. 38,39 These classification systems represent a small number of developed countries. The lack of articles from developing settings is particularly relevant given the applicability of complexity classifications in optimising resource utilisation.…”

Anxiety, depression and psychosocial needs are the most frequent concerns reported by patients: preliminary results of a comparative explorative analysis of two hospital-based palliative care teams in Germany and Japan

“…Therefore, we used a quality indicator based on administrative data to describe the integration of the two PCTs into inpatient end-of-life care. For a planned prospective joint project, the documentation will first be harmonised, based on national and international standards (Guo et al 2018 ; Schoenherr et al 2019 ; Nationales Hospiz-und Palliativregister; Leitlinienprogramm Onkologie 2019 ). The IPOS will also be introduced in PCT-N and in both PCTs a second assessment at the end of the co-management before discharge is planned.…”