Optimising the Virtual Hospice: A mixed-methods study of remote palliative care support covering quality improvement, patient experience and health economics

BACKGROUND "Virtual hospice" care (in which some care, some of the time, is provide remotely—for example via telephone, video, remote patient monitoring or online resources) could supplement in-person services but it is currently relatively little used and poorly characterised. RESEARCH QUESTIONS FOR PROGRAMME GRANT (PG) What are the core features of a high-quality virtual hospice service? How can we strengthen virtual hospice care as part of an integrated service? How does the virtual hospice model perform relative to standard palliative care in terms of quality (including clinical effectiveness, efficiency, timeliness, safety, patient-centredness and equity)? How can we develop a methodologically robust health economic model which simulates national scale-up and informs commissioning decisions? PLAN FOR 14-MONTH PROGRAMME DEVELOPMENT GRANT (PDG) 4 work packages (WPs): In WP1, we will summarise different models of virtual hospice care and use this to inform recruitment of 6 contrasting sites. All will be using virtual hospice but serving different patient populations (in terms of socio-economic and ethnic diversity and clinical case mix), and differing in rurality, local set-up, digital maturity and history. In WP2, we will visit sites, build relationships, train staff, identify a site lead (a proportion of whose time will be bought out in the Programme Grant), introduce the methodology of our Quality Improvement Collaborative (QIC), link participating sites in an online community of practice, and address the quality, completeness and consistency of data sources. We will also interview local stakeholders and prepare a familiarisation document on each site. In WP3, we will design the prospective assessment and health economic evaluation. Working with partner sites, we will investigate the feasibility of patient-level or site level randomisation and decide whether to go with an RCT or a prospective observational study. We will develop a harmonised set of outcome measures spanning the 6 dimensions of quality (clinical effectiveness, efficiency, timeliness, safety, patient-centredness, equity). We will optimise methodology for the economic evaluation and begin to develop a decision model prototype. In WP4, we will write the Programme Grant protocol and build links with local commissioners and policymakers. FUTURE WORK (48-MONTH PROGRAMME GRANT) In phase 1 (18m), we will work with a maximum variety sample of 6 sites to optimise a virtual hospice service, defining a theoretical core and potential adaptations. We will set up a Quality Improvement Collaborative, undertake qualitative studies of the patient experience, and recruit control sites (not using virtual hospice). In phase 2 (24m), we will conduct either a RCT (if feasible) or a non-randomised observational study, with the number of participating hospice services determined by the study design and sample size calculation. We will compare processes, health, wellbeing and economic outcomes, and the patient experience. We will conduct a health economic evaluation alongside the prospective study and in a virtual simulation framework. Phase 3 (6m) will be for finalising data analysis, writing up and dissemination.