Source data: Palliative care outcomes Table PCOC.7
Palliative care outcome measures and benchmarks
In 2009, PCOC and its participating services developed and implemented a set of national outcome measures and associated benchmarks. The PCOC benchmarks are aspirational and reflect good practice based on outcomes in the top 20% of services. These aim to drive service innovation and allow participating services to compare their service nationally. The PCOC outcome measures cover:
- time from the date the patient is ready for palliative care, to palliative care episode start date
- time that the patient spent in an unstable phase
- change in patient symptoms and problems
A full description of each of the PCOC outcome measures and benchmarks reported here is included in the Data Sources section. Table PCOC.11 also presents each benchmark, along with the proportion of palliative care episodes/phases meeting the outcome for each benchmark in different care settings; see Figure PCOC.6. PCOC also reports on 8 casemix-adjusted outcome measures, not reported here (see PCOC 2021a and PCOC 2021b).
Benchmark 1: 90% of patients must have their episode commence on the day of, or the day following, date ready for care
This benchmark aims to assess whether patients received timely palliative care in response to their need. The vast majority of patient episodes (93%) commenced on the day the patient was ready for palliative care, or the day after. This was the case for almost all episodes in hospital (inpatient) settings (98%) and most episodes in community settings (87%).
Benchmark 2: 90% of patients are in the unstable phase for 3 days or less
The unstable palliative care phase indicates that an urgent change in the plan of emergency treatment is required (see Box PCOC.2). This benchmark aims to assess whether there was a timely resolution of unstable palliative care phases. Overall, the majority of unstable phases (88%) were resolved within 3 days or less, with this proportion slightly higher in inpatient settings than in community settings (90% compared with 86%, respectively).
Benchmark 3: Change in symptoms and problems
A change in symptoms and problems during palliative care provides information about the responsiveness and appropriateness of the care plan in place. A positive outcome for patients is to have symptoms and problems in the absent to mild range at the end of a palliative care phase.
Benchmarks 3.1 to 3.10 represent common palliative care symptoms and problems, including pain severity, distress caused by pain, distress caused by fatigue, distress caused by breathing problems, and family/carer problems.
There are 2 benchmarks for each symptom (or problem):
- The first benchmark is that at least 90% of phases that start with patients experiencing absent/mild symptoms (problems) remain absent/mild at the end of the phase. This is reflective of anticipatory care.
- The second benchmark is that at least 60% of phases that start with patients experiencing moderate/severe symptoms (problems) reduce to an absent/mild level by the end of the phase (see Data Sources section for further details). This is reflective of responsive care.
Achieving an absent/mild symptom (or problem) outcome is less likely when the patient has moderate or severe symptoms (or problems) to begin with, especially for those with distress from fatigue and breathing problems, as is reflected in the 60% target for the national benchmark, outcome results observed and Figure PCOC6:
- Around 90% of palliative care phases remained in the absent/mild phase at the end of the palliative care phase ─ pain severity (89%); distress from pain (88%), distress from fatigue (87%), distress from breathing problems (94%), and family/carer problems (88%) ─ thereby reaching (or just below) the benchmark of 90% (Benchmarks 3.1, 3.3, 3.5, 3.7, 3.9).
- Around 60% of palliative care phases that began with moderate or severe pain reduced to absent/mild by the end of the palliative care phase (62% for pain severity and 57% for distress from pain), which was above or just below the benchmark goal of 60% (Benchmarks 3.2, 3.4).
- Less than half of those starting with moderate or severe distress from fatigue or breathing problems reduced to absent/mild phase at the end of the palliative care phase (47% and 50%, respectively), which was well below the benchmark of 60% (Benchmarks 3.6, 3.8).