Use of an automated prospective clinical surveillance tool to drive screening for unmet palliative needs among patients in the final year of life

The inability to reliably identify individuals approaching the end of life presents challenges in providing efficient and high-quality palliative care. We developed an accurate, reliable, and automated tool based on the Hospital One-Year Mortality Risk (HOMR) algorithm that uses electronic health record (EHR) data to identify hospitalized patients at increased risk of death with unmet palliative needs.

In this study, we are implementing the HOMR tool in 20 Ontario hospitals. We developed a custom plan to integrate HOMR into the existing EHR and clinical workflows at each hospital. Patients flagged by HOMR are assessed for uncontrolled symptoms and their desire to engage in advance care planning. The clinical team then addresses any identified unmet needs.

Using hospital chart and provincial administrative data, we will examine the care received by patients identified by HOMR across care settings. We will also interview hospital teams to identify best practices for HOMR implementation; this will enable hospitals that implement HOMR in the future to learn from those that have already carried this out.