Key milestone achieved in the mapping pathways of care for end-of-life project

Healthcare staff looking at information on a board.

We’re delighted to report that we have completed the crucial first phase of this work, which has an overarching aim to identify areas of particular strengths and areas with scope for further improvement. This information will be analysed and reported to support local providers in implementing improvements and standardising end-of-life care.

The first phase of the project required the team to access anonymised information held by the Greater Manchester Public Health Network on place of death for the 93 general practices in Manchester between 2011 and 2015 across three clinical commissioning groups (CCGs) – North, South and Central Manchester. This data indicated whether patients died at their own home, in a care home, in a hospital, hospice or other place. This was supplied to the team in early summer and they have been working since then to establish the proportion of patients who were able to die outside hospital and in their normal home, be it a house or care home. This is measured as ‘Deaths in Usual Place of Residence’ (DiUPR) and is widely seen as a desirable outcome and a proxy for good quality end-of-life care.

It’s often argued that the quality of end-of-life care provided is affected by contextual, social and economic factors such as deprivation and ethnicity. The analysis therefore took into account the lower layer super output area (LSOA) data for each of the 93 general practice populations. Correlations between variables were identified in order to perform a multivariate analysis and predict GP ‘performance’ terms of DiUPR rates in light of the patient population characteristics.

Analysis of the first phase data tells us that, since 2011, the proportion of deaths in hospital have decreased overall, while the proportion of DiUPR has increased. This is generally perceived as a positive trend. There isn’t great variability between the three CCGs for DiUPR rates, but between individual practices there are marked variations. High proportions of DiUPR were also evident within areas of high ethnicity mixes and non-religious/no stated religion populations.

“This is a vital first step in developing a clear picture of the quality of end-of-life care across Manchester, informed by an understanding of the kind of social factors which have a major impact on the quality of care for those at the end-of-life,” says Professor Damian Hodgson, Joint Primary Care Theme Lead and Professor of Organisational Analysis at Manchester Business School. “Moving ahead, the focus is to get a clear understanding of why there is such variation in performance between GP practices, and to understand what best practice looks like on the ground.”

The quantitative analysis will now be taken forward at an individual level (factors of the patient) or practice level (factors of the practice) to produce more detailed evidence on aspects influential to a patient’s end-of-life care pathway. Simultaneously, the data from phase one is helping preparations for phase two of the project. This will be a qualitative process including focus groups and interviews with clinicians involved throughout the end-of-life care spectrum and from across the City. Crucial to this will be the opportunity to explore underlying factors for the findings produced so far from the phase one data.