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Development and validation of a casemix classification to predict costs of specialist palliative care provision across inpatient hospice, hospital and community settings in the UK: a study protocol

Guo, Ping; Dzingina, Mendwas; Firth, Alice M.; Davies, Joanna M.; Douiri, Abdel; O’Brien, Suzanne M.; O'Brien, Suzanne M.; Pinto, Cathryn; Pask, Sophie; Higginson, Irene J.; Eagar, Kathy; Murtagh, Fliss E.M.

Authors

Ping Guo

Mendwas Dzingina

Alice M. Firth

Joanna M. Davies

Abdel Douiri

Suzanne M. O’Brien

Suzanne M. O'Brien

Cathryn Pinto

Sophie Pask

Irene J. Higginson

Kathy Eagar



Abstract

Introduction Provision of palliative care is inequitable with wide variations across conditions and settings in the UK. Lack of a standard way to classify by case complexity is one of the principle obstacles to addressing this. We aim to develop and validate a casemix classification to support the prediction of costs of specialist palliative care provision.

Methods and analysis Phase I: A cohort study to determine the variables and potential classes to be included in a casemix classification. Data are collected from clinicians in palliative care services across inpatient hospice, hospital and community settings on: patient demographics, potential complexity/casemix criteria and patient-level resource use. Cost predictors are derived using multivariate regression and then incorporated into a classification using classification and regression trees. Internal validation will be conducted by bootstrapping to quantify any optimism in the predictive performance (calibration and discrimination) of the developed classification. Phase II: A mixed-methods cohort study across settings for external validation of the classification developed in phase I. Patient and family caregiver data will be collected longitudinally on demographics, potential complexity/casemix criteria and patient-level resource use. This will be triangulated with data collected from clinicians on potential complexity/casemix criteria and patient-level resource use, and with qualitative interviews with patients and caregivers about care provision across difference settings. The classification will be refined on the basis of its performance in the validation data set.

Ethics and dissemination The study has been approved by the National Health Service Health Research Authority Research Ethics Committee. The results are expected to be disseminated in 2018 through papers for publication in major palliative care journals; policy briefs for clinicians, commissioning leads and policy makers; and lay summaries for patients and public.

Journal Article Type Article
Publication Date 2018-03
Journal BMJ Open
Print ISSN 2044-6055
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 8
Issue 3
Pages e020071
APA6 Citation Guo, P., Dzingina, M., Firth, A. M., Davies, J. M., Douiri, A., O'Brien, S. M., …Murtagh, F. E. (2018). Development and validation of a casemix classification to predict costs of specialist palliative care provision across inpatient hospice, hospital and community settings in the UK: a study protocol. BMJ open, 8(3), e020071. https://doi.org/10.1136/bmjopen-2017-020071
DOI https://doi.org/10.1136/bmjopen-2017-020071
Keywords General Medicine
Publisher URL http://bmjopen.bmj.com/content/8/3/e020071
Copyright Statement This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Copyright Statement
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/





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