Frequently Asked Questions (FAQs)
1. What information do we need to collect about our patients in order to receive a PCOC patient outcomes report?
Information is collected at 3 levels – patient, episode and phase.
- Patient level includes data items relating to patient demographics.
- Episode level includes data items which focus on characterising the setting of palliative care service provision. They also provide information relating to the reasons why and how a palliative care episodes starts/ends, the level of support a palliative care patient received both before and after an episode and (where applicable) the setting in which the patient died.
- Phase level data items describe a palliative care patient’s stage of illness, functional impairment and levels of pain and symptom distress, using five clinical assessment tools.
2. When is the information collected?
The information is collected at the beginning of each episode, during the episode (phase change) and at discharge or death. A number of people may be involved in collecting this information, including clinical and administrative staff.
3. How is the information collected?
The information may be entered directly into an electronic patient record or on a clinical form to be entered into a data system at a later date (e.g. SnapShot). PCOC clinical forms are available in an editable version.
4. What is a ‘patient’?
PCOC defines a patient as a person for whom a palliative care service accepts responsibility for assessment and/or treatment as evidenced by the existence of a medical record. Family/carers are included in this definition if interventions relating to them are recorded in the patient medical record. For the purpose of palliative care this includes the bereaved family of the deceased patient.
5. What is an ‘inpatient’?
A patient undergoes a formal hospital admission process with the intent of discharge on a subsequent date to the admission date. Also known as an overnight admitted patient.
6. What is a ‘community patient’?
A community patient is a patient who receives care in the home or other non-hospital or hospice setting (including residential aged care facilities).
7. What is an ‘ambulatory patient’?
An ambulatory patient is
- A patient who is admitted with the intent of being discharged on the same day. For example, day hospital
- A patient who receives care in an outpatient clinic.
8. What is an ‘episode of care’ for PCOC?
An episode of care is a period of contact between a patient and a palliative care service that is provided by one palliative care service and occurs in one setting.
9. When does an ‘episode of care’ start?
An episode of care starts on the date when the first in-person comprehensive palliative care assessment is undertaken and documented using the five PCOC assessment tools.
In the community setting it is the date of first visit or first appointment. In the inpatient setting it is the date of admission or first consultation.
10. When does an ‘episode of care’ end?
An episode of palliative care ends when:
- the patient is formally separated from the current setting of care (e.g. from community to inpatient) or
- the patient dies or
- the principal clinical intent of the care changes and the patient is no longer receiving palliative care.
11. What is the ‘first contact date’ and how is it different from episode start date?
The ‘first contact date’ is the date when a clinician has contact with the patient and / or carer following receipt of referral. First contact may be in-person or by telephone.
In the community setting, first contact is used to determine if the patient is ‘ready for care’, the patient needs, urgency of episode start (admission) and to arrange home visit.
In the inpatient setting, commonly, first contact occurs on admission. In this situation first contact and episode start date are the same.
12. What is the ‘referral date’?
The date a service receives a referral to provide palliative care for a patient for this episode. The referral can be either written or verbal.
13. What should be recorded for ‘referral source’?
The facility or organisation from which the patient was referred for this specific episode.
14. What is ‘date ready for care’?
The date the patient is ready and available to receive palliative care. This is determined by the patient or carer at first contact or by the referrer.
If a referral is received but the patient is not available for care, the date ready for care will be the date specified by the patient / carer. Reasons for the patient not ready for care may include:
- early referral for planning purposes
- planned holidays.
15. What order should ‘date of first contact’ and ‘date ready for care’ be in?
These two dates can be in any order but both must be after (or the same as) the referral date and before (or the same as) the episode of care start date.
16. What is a palliative care phase?
The palliative care phase identifies a clinically meaningful period in a patients’ condition. The palliative care phase is determined by a holistic clinical assessment which considers the needs of the patients and their family and carers.
There are five phases in the palliative care phase assessment:
- Bereaved (post death support).
The phases provide a framework for referral, triage and care planning, as well as communication between teams. Phases were based on the following principles:
- In palliative care, the focus is on patient needs, goals and priorities rather than the disease
- In palliative care, the patient, carer(s) and family are the unit of care
- Palliative care patients have episodes of care that include acute exacerbations
- Such episodes are applicable at home or hospital (Smith 1993).
17. What do I record for place of death?
Place of death is only completed if the episode ends in death. For patients who die in an inpatient setting the only option is ‘hospital’. For patients who die in the community setting the options are:
- Residential aged care facility.
18. What is Activity Based Funding?
Activity Based Funding (ABF) is the system by which governments can fund their contribution to public hospital services. ABF is used to monitor, manage and administer the funding of health care provided by public hospitals. ABF is based on the activity undertaken. As most hospital activity involves treating patients or cases, the term ‘casemix funding’ is also used. ‘Casemix’ literally means the ‘mix of cases’ that a health service treats. More information about ABF is available here.
1. Why are the PCOC outcome measures and benchmarks the same for inpatient and community services?
The PCOC outcome measures are set through patient eyes, that is, they are based on patient need rather than service models. Whilst it is acknowledged that there is wide variation in palliative care service models across Australia, patients expect the same quality of palliative care regardless of setting of care, or location.
2. How often are PCOC reports produced?
Patient Outcome Reports, State Reports and National Reports are available bi-annually. April (July to December reporting period) and October (January to June reporting period).
3. What is the time frame for submitting data?
Data is submitted to PCOC January 1 and July 1 for bi-monthly Patient Outcome Reports. A series of quality checks are run before reports are produced. The process for submission to PCOC varies depending on the IT system used.
4. What is the process for checking the quality of the data?
Data processing occurs when the data is submitted to PCOC. During this time the PCOC team conducts a series of data quality checks. The quality of the data needs to be of a satisfactory level before data is entered into the report dataset and a service report generated. The data processing period allows the data to be reviewed and, if required, corrected prior to final submission. There is a requirement that the service / organisation ensure the accuracy and reliability of the information collected.
5. Can I test the quality of data mid way between reporting periods?
Yes, interim quality checks are performed for:
- All new services prior to the first submission of six monthly data to check the number of patients and episodes and the data quality.
- Services already participating in PCOC to test the quality of data or detect problems or issues.
- Services wishing to correct errors part way through a report cycle due to changes in processes in recording of data or changes in data entry staff.
6. Our service’s care is provided by multiple teams – is there a way to record this?
Yes. The PCOC Version 3 dataset enables data to be entered under a Team ID.
For more information on setting up team identifiers in your database please contact your Quality Improvement Facilitator.
If you are using SNAPshot 3.90g to enter data, you can refer directly to the SNAPshot User Manual (page 30).
1. My data quality report is telling me I have duplicate phases – what have I done wrong and how do I fix it?
Two phase records in a row have the same phase type. There are two possible reasons for this:
- One of the phase types has been entered incorrectly. In this case, the correct phase type should be entered.
- Only one phase record should have been entered for the period of time. In this case, delete the duplicate phase record.
Please note that phase level data (level 3) only needs to be entered at episode start, phase change and discharge (or case closure).
2. The error “assessment scores at discharge” appeared on my quality report, what does this mean?
The patient’s SAS, PCPCSS, AKPS and/or RUG-ADL clinical assessments were not entered at the end of the phase in which the patient was discharged. To correct this error please enter the clinical assessment scores at the end of the phase in which the patient was discharged. If you do not have access to the clinical assessment scores, please enter ‘not assessed’ for these data items.
3. What areas should I focus on in my data quality report?
The aim of checking your data submission and sending you a data quality report is to ensure the data is as accurate and complete as possible for your PCOC report. You are encouraged to correct as many of the errors as possible in your data quality report.
The PCOC data quality report is broken up into three sections:
- Section 1: Data Item Errors: This section outlines errors and issues related to how the data has been entered.
- Section 2: Missing Items: This section details the areas where information is missing at the patient and episode levels. The issues listed in this area may be caused by clinical data recording or data entry.
- Section 3: Missing Clinical Assessments: This section details missing clinical assessment data. The issues listed in this area may be caused by clinical data recording or data entry.