palliAGED and CareSearch - more than partners in palliative care
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palliAGED and CareSearch - more than partners in palliative care

A blog post written by Dr Katrina Erny-Albrecht, Senior Research Fellow, CareSearch, College of Nursing and Health Sciences, Flinders University

Tasked with clarifying the relationship between CareSearch and palliAGED following the recent new CareSearch portal release, my mind sprang to: inter-related, linked, connected, twin or sister sites, network, partners. But on reflection it is perhaps better explained by looking at hub and spoke models.

Hub and spoke models have been widely adopted in health care to improve access and allocation of resources. This includes workforce.  Often an anchor establishment (hub) offers a full array of services, and this is complemented by secondary establishments (spokes) offering fewer but commonly needed services. Patients needing more intensive or specialised services are directed to the hub for treatment. [1] But that’s just one model.

Bostock and Brit’s examination of hub and spoke models in the health and social care arena generated a matrix comprising ten different models. [2] Each model is defined according to the management structure and context and characteristics of the hubs and spokes. Relationships are an important part of this. Interestingly, elements of the collaborative CareSearch model map to at least six of these distinct hub and spoke models. CareSearch’s relationship with its partners reflects a hub and spoke model.

In Australia, CareSearch is the main campus or hub for evidence-based information in palliative care. Information that spans the life-course and contexts of care with the aim of supporting quality palliative care for all Australians. It is more than using evidence, it is about making evidence available and transparent, and rendering it useful for practice.

Based on this expertise, in 2016 CareSearch was commissioned by the Department of Health to create an enhanced knowledge base for palliative care in aged care - palliAGED. Drawing on the COMPAC and APRAC guidelines that it replaced, palliAGED applied the CareSearch model to develop an evidence-based resource tailored to the needs of the aged care sector.

The CareSearch hub is strengthened by partnering with other organisations, the spokes, to develop specific support and guidance that extends beyond that offered by CareSearch. These partnerships are based on having a formal agreement in place and they draw on the CareSearch model’s quality processes, evidence, and functionality to develop tailored products.  In the new portal, these partners with a shared evidence ethos provide expert and focused support for aged care, primary care, paediatric care, acute care, home-based care and for people with intellectual disability. Structurally, each partner or spoke has independent management and processes to harness expertise and develop products tailored to specific needs, contexts, and audiences. Interaction between these spokes and CareSearch are bi-directional and dynamic. CareSearch advises on development from an evidence perspective while supporting access to and dissemination of information held within the spokes. The spokes in-turn add breadth and depth to the hub. The overall model avoids duplication of resources while extending the reach of information and tailored support to where it is needed. In the new portal we have deliberately increased visibility of our partners (spokes) to promote awareness and use of these resources where they can be of greatest value.

So where does that leave palliAGED? Well, palliAGED is described as one of the nine CareSearch partners, so potentially it is a spoke. Yet, in contrast to the other partners it is fully managed by CareSearch and hence shares operational policies and procedures, it was also built on the same rigorous approach to evidence and sector collaboration, it similarly focuses on providing access to and use of evidence to inform best practice, and a single team works across both.  In Bostock and Brit’s matrix palliAGED is more than a partner, it qualifies as part of a multi-hub model with CareSearch.

Such multi-hub networks might arise where ‘spoke to hub access proves impractical’. [1] In this case it is the location of palliAGED within CareSearch that is impractical. Why is that the case?  CareSearch provides support across the life-course and demand for palliative care is currently increasing across most age groups. [3] Yet in absolute numbers the needs of people aged 75 years and older overwhelmingly dominate this demand. They accounted for almost 50% of hospital admissions for palliative care in 2017-18.[3] And this is likely to increase with many of the more than one million people accessing Commonwealth supported aged care having chronic and complex conditions that could benefit from palliative care. In addition to this, while end of life care is core business for residential aged care, it is both a place to live and a place to die.[4] Support in this context must take this into consideration and distinguishes it from hospice and specialist services engaged with terminal care. As a single hub the efforts of CareSearch might become skewed towards the greater demand from aged care. This risks, leaving younger cohorts and those who care for them unsupported with evidence and information. Establishment of palliAGED as a secondary hub solves this problem. It also allows for greater breadth in topic coverage to reflect the expanded remit of many aged care services.

The multi-hub model of CareSearch and palliAGED started to take shape with consolidation of our aged care resources in 2017-2020. It is now maturing to meet the diverse and growing needs and contexts of palliative care across the life course. Synergy between CareSearch and palliAGED ensures rigour and quality at the hub level while maximising relevance, reach and resources through the spokes. The unique brand identity of palliAGED enables the focus to be centrally located within aged care and to address the specific context and needs of this sector. As we work to further refine the model it is hoped that this multi-hub relationship between CareSearch and palliAGED will help everyone to benefit from evidence informed palliative care.

References

  1. Elrod JK, Fortenberry JL Jr. The hub-and-spoke organization design: an avenue for serving patients well. BMC Health Serv Res. 2017 Jul 11;17(Suppl 1):457. doi: 10.1186/s12913-017-2341-x.
  2. Bostock L, Britt R. Effective approaches to hub and spoke provision: a rapid review of the literature. Social Care Research Associates. 2014 Sep. 
  3. Australian Institute of Health and Welfare. (2021). Palliative care services in Australia.  Admitted patient data [Internet]. Canberra: Australian Institute of Health and Welfare, 2021.
  4. Gibson D. Who uses residential aged care now, how has it changed and what does it mean for the future? Aust Health Rev. 2020 Dec;44(6):820-828. doi: 10.1071/AH20040.

 

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Dr Katrina Erny-Albrecht, Senior Research Fellow, CareSearch, College of Nursing and Health Sciences, Flinders University

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The views and opinions expressed in Palliative Perspectives are those of the authors and are not necessarily supported by CareSearch, Flinders University and/or the Australian Government Department of Health and Aged Care.