Evaluating the Navigate Care Model: clinical palliative care pathways based on anticipated care outcomes

The Navigate Care Model (NCM) specifies clinical pathway assignments for hospice patients based on the anticipated outcomes of death, discharge home, or discharge into residential care. This study, set in a freestanding, inpatient hospice, evaluated the effects of NCM implementation on 338 patients, 154 family members and the organization, including 49 staff. Accuracy of pathway assignment on admission was also assessed. The results indicate that patients' symptoms were managed as well or better than previously, as compared with 1998 data. Discharged patients reported being highly satisfied with care and there were fewer readmissions. Families reported greater satisfaction with care than those surveyed previously, as compared with 1999 data. Staff reported initial negative effects but elected to retain a refined version of the model after the study. Pathway assignments on admission were correct 64% of the time, 92% correct when assignment was for terminal care. Clinical pathways based upon the expected outcomes of death or discharge appear to offer benefits for patients and families.