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Evaluating and improving care

Palliative day care

Despite its rapid expansion, hospice day care has never been rigorously evaluated. A questionnaire survey of all day care units in the London Region identified a wide range of services (Higginson, Hearn, Myers et al 2000). From these the investigators – Higginson, Goodwin, Normand, and Douglas (these last two individuals from London School of Hygiene and Tropical Medicine), and Naysmith and Myers (Pembridge Palliative Care Service) and Amesbury (Chichester) identified six units, representing different more medical or social models of support, for a comparative evaluation.

A multiprofessional project group was established with representatives from all units. All units collected data over two years on newly referred patients to palliative day care and a comparison group, following individuals until discharge or death. The results show that patients attending day care report that they like it, and describe the main benefits as "getting out" and "meeting others" (Higginson and Goodwin 2001; Goodwin, Higginson, Myers et al. 2002; Goodwin, Higginson, Myers et al. 2003). However, there was little change on traditional quality of life measures. We are currently analyzing whether there are differences in quality of life and data from the sixth unit (in Chichester), which was last to be established and where in addition to a concurrent comparison group of patients not receiving day care, we have collected information about patients before day care was available (before group). An economic evaluation has been included assessing the cost of day care and whether it substitutes or supplements existing services.

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