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What is happening with the Hospice-led Innovation Study to Improve Care?

Author: Claire Hawksworth
28 February 2018

Claire Hawksworth is research lead at St Giles Medical, supporting the Hospice-led Innovation Study to Improve Care (HOLISTIC). Here she explains the progress the study has made so far.

Instinctively, we all know that hospice-led initiatives play an important role in minimising inappropriate hospital usage at the end of life, but there is a lack of robust data demonstrating any potential impact. The Hospice-led Innovation Study to Improve Care (HOLISTIC) seeks to address this gap, evaluating the effect of different hospice innovations on hospital usage for people at the end of life, and examining the factors contributing to success.  

Evidence to underpin palliative care is lagging behind other specialities. This study seeks to redress that imbalance.  Ultimately, we hope that strengthening the evidence base in this area will help hospices make the case for investment in services by their local commissioners.  

How is the study structured?

This mixed-method study commissioned by NHS England involves both quantitative and qualitative elements. The quantitative arm employs Hospital Episode Statistics (HES) data to determine any population effect of some of the hospice interventions, while the qualitative part aims to elicit critical success factors through interviews and framework analysis. 

Avoided hospital admission is difficult to measure, not least because of numerous variables and confounding factors. It is anticipated that the HOLISTIC study’s ‘difference of difference’ analysis will partly control for site-specific differences and other trends in hospital utilisation over time by comparing any variance with a control cohort of patients. A leading consultancy are providing pro bono support to the study.

The study involves researching 27 innovations at 25 hospices. This multifactorial approach is considered a strength. The relatively large number of sites involved enables us to explore a wide range of innovations, delivery models and contextual factors. This includes urban and rural settings, demographic profiles, different diagnoses and funding sources.

The project is being supported by a Steering Committee comprising experts from academia, NHSE and front-line service delivery.

This is a ground-breaking and complex study, which  involves multiple centres and the use of complementary research methodologies. It is difficult to isolate the effect of specific interventions in complex health systems.  However, the methodology has been designed to give us the best chance of evidencing the impact of hospice-led interventions on hospital use at the end of life. 

We know that as a result of the need to have strict inclusion criteria, there are many hospice-led innovations that are not included in the study.  In the final report we will include appropriate reference to other innovations aiming to reduce hospital usage at the end of life.  We are also acutely aware of the need to contextualise our findings and to interpret any conclusions with a degree of caution. The HOLISTIC study is real world evidence research, and this provides an exciting opportunity to determine the degree to which these innovations produce their desired effect in association with numerous variables.

Progress so far

Last November, we produced a brief update on progress with the study that we launched at the Hospice UK National Conference.

So far, we have spoken to nearly 180 stakeholders and travelled 5,600 miles across England.  We have also spoken with families, carers and patients, whose voices are important in understanding what matters most to people. 

The quantitative branch of the study has been delayed by data access issues, but we are hoping to be given the go ahead soon and commence analysis in the coming weeks. Our final report and various implementation tools will be available in the early summer. Several roll-out meetings are planned to disseminate learning across England.


Demand on our palliative care services will continue to grow as our population ages. The HOLISTIC study will hopefully contribute to the current system evaluation taking place at a national level. It aligns with, and complements, the aims of the Government’s national commitment on end of life care in supporting people to have more choice and control at the end of life. It will consider questions such as: can successful innovations be replicated in other areas? And can such services deliver better outcomes for patients at less cost to the NHS?

In the long run, evidence from the HOLISTIC study may aid end of life care service redesign, by delivering shared learning across the NHS, hospices and other care providers. Most importantly, it will seek to contribute to the improvement of patient experiences and outcomes, enabling more people to get the support they need at the end of life.

And once we have drawn breath, we need to reflect on what we do next. Any thoughts or suggestions would be appreciated! Get in touch via

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Comments | 1



would like to hear of any research studies especially in Palliative care

28/03/2018 16:13:24

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