|
Community pilot | Interstate Implementation
The RPC Program was evaluated in 2005 and 2006. The initial evaluation was of the 17 residential aged care facilities and two community based palliative care services in the Austin catchment area.
The second evaluation concerns three of the lead sites; Hunter New England Health Service, Queen Elizabeth Hospital and The Townsville Hospital.
Evaluation of RPC Program Implementation to Residential Aged Care and Palliative Care Services, 2006 | back to top ^
 Click here to download Executive Summary RPC Community Evaluation 12/08/2007,18:32 120.81 Kb
The RPC Program was extended to 16 Residential Aged Care Facilities (RACFs), one Supported Residential Service (SRS) and two community based Palliative Care Services (PCSs) in the Austin Health catchment area from 2004-05. An extensive evaluation of the implementation in these facilities and services was submitted to the Department of Health and Ageing in January 2006. This evaluation detailed the impacts and outcomes of the Program, with many successful outcomes whereby residents requests for medical treatment were discussed, documented and met.
Factors that facilitated implementation:
o leadership from managers
o commitment from the organisation’s governing body
o training of adequate numbers of appropriate staff in advance care planning skills
o the provision of consultation and support to facilities
o comprehensive system changes to documentation processes
o the provision of support to RPC trained staff.
In organisations where there was a pre-existing philosophy supporting discussion of end-of-life treatment or care wishes, the RPC Program also assisted in the provision of more comprehensive delivery of care.
Challenges to the Program implementation included:
o constraints relating to time, resourceing and staff skills
o high management and staff turnover in some organisations
o difficulties in developing a systemised approach to incorporating the Program into practice and process of health care delivery.
The RPC model of advance care planning had a significant impact on the level to which consumers were involved in choices regarding their future care and on the skill and the confidence and involvement of health service providers in facilitating the process. The evaluation provided evidence that if a person’s end-of-life wishes are discussed in a sensitive and supported manner, and documented clearly and consistently within and between service sectors, then people receive health care in their place of choice and avoid receiving unwanted and, often, burdensome treatments. The perception of the patients or residents, their families and the health professionals was also that the process of advance care planning improves quality of care and increases awareness of, and respect for, patient autonomy and human dignity.
For further details about the 2006 Evaluation of RPC Program’s Extension into Residential Aged Care Facilities please contact the Austin RPC Office
Evaluation of the national implementation of the RPC Program | back to top ^ Click here to download National Implementation Executive Summary 12/08/2007,18:34 80.83 Kb
An extensive evaluation of the implementation of the RPC Program at three of the seven interstate hospitals was conducted in 2006. These three health services were:
o The Queen Elizabeth Hospital and Health Service, Adelaide SA
o Hunter New England Health Service – John Hunter Hospital, Newcastle NSW
o The Townsville Health Service, Townsville Hospital QLD
Overall the delivery of RPC to these states was very successful. This was due to the systematised approach of the RPC model which incorporated the following:
o Training of health care providers to initiate conversations with adults regarding views about future medical care and to skilfully facilitate planning with each individual.
o Implementing system changes to make sure all Advance Care Plans are clear to all involved and specific to each person, and that they are available when needed, and
o The organisational and cultural changes so that health care providers appropriately follow plans in a thoughtful and respectful way.
Facilitating Factors
All three sites identified that the Program needs to become part of the existing health care culture, and in order for implementation to be successful, required:
o Consultation
o support from the executive
o leadership from executive, clinical leaders and nursing managers
o System changes.
o Education and skill development
o Involvement of the state Public Advocate or Adult/Public Guardian and use of statutory documents
Barriers to implementation
o time was a major challenge:
o challenge of implementing in acute sector (space, staffing, time issues)
o local environment issues disrupting implementation
o challenges relating to use of statutory documents (dependent upon state)
Conclusions
The evaluation of the national implementation of the RPC Program, at three interstate sites, established that advance care planning had a significant impact on the level to which consumers are involved in choices regarding their future care, and on the skill, confidence and involvement of health service providers in facilitating the process.
The Program provided evidence that if a person’s end-of-life wishes are discussed in a sensitive and supported manner, and documented clearly and consistently within and between service sectors, then people receive health care in their place of choice and avoid receiving unwanted and, often, burdensome treatments.
The perception of the patients, their families and the health professionals was that the process of advance care planning improves quality of care and increases awareness of, and respect for, patient autonomy and human dignity.
Variations were identified with regard to the organisational issues and facilitating factors and barriers to implementation across the three sites, however it appears from the data available that all sites had the desired effect of the Program implementation.
For more infromation on the 2006 Evaluation of the RPC Program at the interstate sites (acute) please contact the Austin RPC Office
Acute Health implementation and evaluation across Victoria
In Victoria, RPC was initially funded under the Hospital Admission Risk Program (HARP) by the Victorian Government Department of Human Services (DHS). After the initial evaluation of HARP, a number of acute health services now receive funding for advance care planning, from the Metropolitan Health and Aged Care Services of DHS through their Sub-acute and Transition Care Services stream. A Reference Group has been established for the reporting and evaluation of RPC implementation.
|
[Print]