A cost analysis of implementing facilitated improvements in hospital palliative care using patient reported experience measures: the LEAHP (Listen Empower Act - Hospital Palliative care) bundle.

BACKGROUND: Acute inpatient care does not always align with the known palliative care needs and preferences of people with deteriorating health. The LEAHP (Listen, Empower and Act to improve Hospital Palliative care) bundle is a novel intervention combining collection and feedback of patient reported experience measures (PREMs), an understanding of context, co-design of a shared vision and facilitated clinician-led improvements in quality of care, for inpatients with palliative care needs. We describe the resource requirements for pilot implementation of the LEAHP bundle, and potential cost considerations for sustaining and spreading this initiative. METHODS: A prospective costing analysis was conducted alongside a pre-post implementation study between May 2022 and Nov 2023 across three wards in a large hospital in Australia. A health service perspective was taken, with costs collected during the study period and valued in 2023 Australian dollars. Costs included Project Team and Clinical Team labour, as well as non-labour resources. Time-driven, activity-based costing methods were adopted, with implementation activities categorised using a modified Expert Recommendations for Implementing Change (ERIC) Framework headings. A scenario analysis explored cost reductions that would support sustaining and spreading of the initiative. RESULTS: The total average cost of implementing the LEAHP bundle for each ward over approximately 12 months was $37,019; consisting of $26,289 (71%) Project Team, $8,870 (24%) Clinical Team, and $2,053 (5%) non-labour average costs. The greatest percentage of costs was attributed to the Facilitator (average $13,488 per ward, 36% overall) and the Research Nurse (average of $10,868 per ward, 29%). In a scenario analysis testing sustainment and spread, the total average cost of implementing the LEAHP bundle was an average of $25,251 per ward ($15,212 [60%] Project Team, $8,373 [33%] Clinical Team, and $1,667 [7%] non-labour costs) – 32% less than the base case. CONCLUSIONS: Pilot implementation of the LEAHP bundle required investment from both the Project Team and Clinical Team to enable facilitation, collection of PREMs, an understanding of context, and engagement of clinicians to implement improvements for inpatients with palliative care needs. Sustainment would be contingent on the resources required for facilitation in a changing clinical context and on mechanisms for collecting and processing the PREM data. Future research is warranted to explore sustainable and widescale implementation of this promising intervention.