Pilot Testing of Triage Coding System in Home-based Palliative Care Using Edmonton Symptom Assessment Scale
Identifieur interne : 008008 ( Ncbi/Curation ); précédent : 008007; suivant : 008009Pilot Testing of Triage Coding System in Home-based Palliative Care Using Edmonton Symptom Assessment Scale
Auteurs : Sunil Dhiliwal [Inde] ; Naveen Salins [Inde] ; Jayitha Deodhar [Inde] ; Raghavendra Rao [Inde] ; Mary Ann Muckaden [Inde]Source :
- Indian Journal of Palliative Care [ 0973-1075 ] ; 2016.
Abstract
Home-based palliative care is an essential model of palliative care that aims to provide continuity of care at patient's own home in an effective and timely manner. This study was a pilot test of triage coding system in home-based palliative care using Edmonton Symptom Assessment System (ESAS) scale.
Objective of the study was to evaluate if the triage coding system in home-based palliative care: (a) Facilitated timely intervention, (b) improved symptom control, and (c) avoided hospital deaths. Homecare services were coded as high (Group 1 - ESAS scores ≥7), medium (Group 2 - ESAS scores 4–6), and low (Group 3 - ESAS scores 0–3) priority based on ESAS scores. In high priority group, patients received home visit in 0–3 working days; medium priority group, patients received home visit in 0–10 working days; and low priority group, patients received home visit in 0–15 working days. The triage duration of home visit was arbitrarily decided based on the previous retrospective audit and consensus of the experts involved in prioritization and triaging in home care.
“High priority” patients were visited in 2.63 ± 0.75 days; “medium priority” patients were visited in 7.00 ± 1.5 days, and “low priority” patients were visited in 10.54 ± 2.7 days. High and medium priority groups had a statistically significant improvement in most of the ESAS symptoms following palliative home care intervention. Intergroup comparison showed that improvement in symptoms was the highest in high priority group compared to medium and low priority group. There was an 8.5% increase in home and hospice deaths following the introduction of triage coding system. There was a significant decrease in deaths in the hospital in Group 1 (6.3%) (
Pilot study of testing triaging coding system in home-based palliative care showed, triage coding system: (a) Facilitated early palliative home care intervention, (b) improved symptom control, (c) decreased hospital deaths, predominantly in high priority group, and (d) time taken for intervention from triaging was a significant predictor of survival.
Url:
DOI: 10.4103/0973-1075.173943
PubMed: 26962276
PubMed Central: 4768444
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when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000750</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000750</idno><idno type="wicri:Area/Pmc/Curation">000750</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000750</idno><idno type="wicri:Area/Pmc/Checkpoint">000704</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000704</idno><idno type="wicri:Area/Ncbi/Merge">008008</idno><idno type="wicri:Area/Ncbi/Curation">008008</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Pilot Testing of Triage Coding System in Home-based Palliative Care Using Edmonton Symptom Assessment Scale</title><author><name sortKey="Dhiliwal, Sunil" sort="Dhiliwal, Sunil" uniqKey="Dhiliwal S" first="Sunil" last="Dhiliwal">Sunil Dhiliwal</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Palliative Medicine, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Palliative Medicine, Tata Memorial Centre, Parel, Mumbai, Maharashtra</wicri:regionArea><wicri:noRegion>Maharashtra</wicri:noRegion></affiliation></author><author><name sortKey="Salins, Naveen" sort="Salins, Naveen" uniqKey="Salins N" first="Naveen" last="Salins">Naveen Salins</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Palliative Medicine, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Palliative Medicine, Tata Memorial Centre, Parel, Mumbai, Maharashtra</wicri:regionArea><wicri:noRegion>Maharashtra</wicri:noRegion></affiliation></author><author><name sortKey="Deodhar, Jayitha" sort="Deodhar, Jayitha" uniqKey="Deodhar J" first="Jayitha" last="Deodhar">Jayitha Deodhar</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Palliative Medicine, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Palliative Medicine, Tata Memorial Centre, Parel, Mumbai, Maharashtra</wicri:regionArea><wicri:noRegion>Maharashtra</wicri:noRegion></affiliation></author><author><name sortKey="Rao, Raghavendra" sort="Rao, Raghavendra" uniqKey="Rao R" first="Raghavendra" last="Rao">Raghavendra Rao</name><affiliation wicri:level="1"><nlm:aff id="aff2">Bangalore Institute of Oncology, Bengaluru, Karnataka, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Bangalore Institute of Oncology, Bengaluru, Karnataka</wicri:regionArea><wicri:noRegion>Karnataka</wicri:noRegion></affiliation></author><author><name sortKey="Muckaden, Mary Ann" sort="Muckaden, Mary Ann" uniqKey="Muckaden M" first="Mary Ann" last="Muckaden">Mary Ann Muckaden</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Palliative Medicine, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Palliative Medicine, Tata Memorial Centre, Parel, Mumbai, Maharashtra</wicri:regionArea><wicri:noRegion>Maharashtra</wicri:noRegion></affiliation></author></analytic><series><title level="j">Indian Journal of Palliative Care</title><idno type="ISSN">0973-1075</idno><idno type="eISSN">1998-3735</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Introduction:</title><p>Home-based palliative care is an essential model of palliative care that aims to provide continuity of care at patient's own home in an effective and timely manner. This study was a pilot test of triage coding system in home-based palliative care using Edmonton Symptom Assessment System (ESAS) scale.</p></sec><sec id="st2"><title>Methods:</title><p>Objective of the study was to evaluate if the triage coding system in home-based palliative care: (a) Facilitated timely intervention, (b) improved symptom control, and (c) avoided hospital deaths. Homecare services were coded as high (Group 1 - ESAS scores ≥7), medium (Group 2 - ESAS scores 4–6), and low (Group 3 - ESAS scores 0–3) priority based on ESAS scores. In high priority group, patients received home visit in 0–3 working days; medium priority group, patients received home visit in 0–10 working days; and low priority group, patients received home visit in 0–15 working days. The triage duration of home visit was arbitrarily decided based on the previous retrospective audit and consensus of the experts involved in prioritization and triaging in home care.</p></sec><sec id="st3"><title>Results:</title><p>“High priority” patients were visited in 2.63 ± 0.75 days; “medium priority” patients were visited in 7.00 ± 1.5 days, and “low priority” patients were visited in 10.54 ± 2.7 days. High and medium priority groups had a statistically significant improvement in most of the ESAS symptoms following palliative home care intervention. Intergroup comparison showed that improvement in symptoms was the highest in high priority group compared to medium and low priority group. There was an 8.5% increase in home and hospice deaths following the introduction of triage coding system. There was a significant decrease in deaths in the hospital in Group 1 (6.3%) (<italic>χ</italic><sup>2</sup> = 27.3, <italic>P</italic> < 0.001) compared to Group 2 (28.6%) and Group 3 (15.4%). Group 2 had more hospital deaths. Interval duration from triaging to first intervention was a significant predictor of survival with odds ratio 0.75 indicating that time taken for intervention from triaging was more significantly affecting survival than group triaging.</p></sec><sec id="st4"><title>Conclusion:</title><p>Pilot study of testing triaging coding system in home-based palliative care showed, triage coding system: (a) Facilitated early palliative home care intervention, (b) improved symptom control, (c) decreased hospital deaths, predominantly in high priority group, and (d) time taken for intervention from triaging was a significant predictor of survival.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Hearn, J" uniqKey="Hearn J">J Hearn</name></author><author><name sortKey="Higginson, Ij" uniqKey="Higginson I">IJ Higginson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Thayyil, J" uniqKey="Thayyil J">J 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