Improving end-of-life care in the community using the RESPECT on-line prognostication tool
Manuel, D (NPI); Hsu, A; Beach, S; Bennett, C; Spruin, S; Tanuseputro, P
People in the community who are frail may receive fragmented care in many jurisdictions – especially as they near the end-of-life – due to poor prognostication. One challenge is the lack of tools to identify people across a spectrum of care needs. RESPECT (Risk Evaluation for Support: Predicting Elder life in the Community Tool) is a prognostic tool developed using population-level data from Ontario. The study base consisted of Ontarians who received a structured home care assessment, using the Resident Assessment Instrument for Home Care (RAI-HC), between January 1, 2007, and January 1, 2014. The RAI-HC data was used to assess risk factors for mortality, which was estimated using Cox Proportional Hazards regression. The final risk assessment tool will be implemented on projectbiglife.ca. To assess the value of prognostication tools in community care, focus groups will be held to evaluate the preliminary online tool, potential metrics, and the acceptability of mortality risk information. Early findings from pre-test consultations and pilot-phase interviews with community care providers suggest that risk stratification instruments play an important role in community care planning. The on-line implementation of this prognostication algorithm with an adaptive design enables its ease of use by health care providers, the patients, as well as their caregivers. Preliminary results suggest the on-line implementation of RESPECT presents a valued opportunity for research knowledge translation and patient engagement.