Request for Proposals (RFP 008) for Synthesis Research: Integration of Care at the End of Life

I. Deadline

• Full proposals must be received by March 15, 2002 (12:00 noon E.S.T.).

II. Funding and General Information

• Maximum funds available for all projects is $200,000.
• Proposals with budgets that exceed $200,000 will be deemed ineligible, without exception.
• Maximum project duration is 12 months from date of funding.
• Preference will be given to proposals that clearly demonstrate national relevance, and/or that compare activities and results across multiple jurisdictions and/or health regions.

III. Scope of Competition

Objective

Health Canada is inviting proposals for a synthesis of current end-of-life care/service delivery models (Canadian and international) which meet the system needs of a complete continuum of care, as well as an identification of models or approaches that best foster the integration of care.

Context

Individuals who are nearing death suffer multiple co-morbid conditions and the trajectory toward death often involves a period of months which has been referred to as "chronic living-dying" ( Fields and Cassel, 1997) between the point of diagnosis of an incurable illness and the stage of imminent death. During this stage of "chronic living-dying", the individual may use a wide range of services, including support services, and may move across care settings. These services may be provided through an integrated palliative care program, or through some other combination of services with various levels of coordination.

Although palliative care in Canada has historically been focused on end-stage cancer care, multi- disciplinary palliative care has increasingly been viewed as an appropriate model for the provision of end-stage care for all terminal conditions across all age groups.

In its effort to coordinate the development of a strategy for improving the quality of end-of-life (palliative) care in Canada, Health Canada is seeking to improve its understanding of the current state of integration of care at the end of life, specifically the impacts on patient and family care and patient outcomes of various existing end-of-life care/delivery models, as well as identifying and describing the components of a best practice model.

Policy Research Questions

Proposals must address all of the following questions.

1. How have recent developments toward increased health system integration and/or regionalized delivery of services affected the delivery of health care services to persons with terminal illness? Various models of integrated care/delivery should be identified and their components described. The components should include, for example, a range of those identified in the Square of Care model, presented on page 15 of the 2001 Proposed Norms of Practice for Hospice Palliative Care report, prepared by the Canadian Palliative Care Association.
2. Identify the impacts that integrated end-of-life programs have had with respect to the following indicators. Consideration should be given to the perspectives of the patient, family, health care provider and health care administrator, where applicable:

1. continuity of care (e.g., ease of movement between various levels/settings of care; placement or discharge coordination services);
2. accessibility of services (e.g., waiting/transition times between settings; cost of non-insured services);
3. length of stay in each type of care setting (e.g., home, hospital, hospice);
4. patient outcomes (e.g.; the proportion of deaths occurring in each type of care setting identified in (iii) above; ability to meet physical, psychological and social needs of patient and family);
5. cost-effectiveness of integrated versus traditional models of care delivery.

3. Given the various models of integrated care identified and their impacts and outcomes, identify and describe a best practice model(s) from the point of view of the infrastructure or components needed to support effective integrated health systems that ensure quality of care of patients and their families at the end of life (e.g., the Square of Care model).
4. What are the policy implications for the various levels of government (federal/provincial/territorial/regional/municipal) of a shift towards the provision of end-of-life care in the context of integrated health care/delivery systems?

IV. Policy Contact

Prior to developing a proposal, policy inquiries should be directed to:

Dr. Sue Morrison Manager, Secretariat on Palliative and End-of-Life Care Health Services Division Health Policy and Communications Branch Health Canada Tel: (613) 946-9851 Email: Sue_Morrison@hc-sc.gc.ca

The policy contact is responsible for ongoing interaction with applicants to provide contextual guidance and advice. We encourage all applicants to consult with the policy contact prior to preparing a proposal.

The policy contact is to be consulted on the policy issues and proposal content only. Formatting, eligibility/ineligibility, and other administrative questions (such as time frames, budgets, etc.) should be directed to the HPRP Program Officer. As the policy contact will not provide letters of support, applicants must outline their interaction(s) with Health Canada staff in the body of the proposal.

Do not forward proposals (draft or otherwise) to the policy contact for review at any time. Preliminary review of a proposal by the policy contact will be deemed a conflict of interest and may result in the disqualification of your proposal.

V. How to Apply

Full proposals must be received before 12:00 noon (E.S.T.) on March 15, 2002.

Researchers are strongly encouraged to consult the Health Policy Research Program Guide before preparing a proposal. If you are interested in submitting a proposal in relation to this

RFP, please refer to the Application for research funds and Instructions for completing the application form for research funds.

When developing a proposal, please direct inquiries regarding eligibility, the proposal preparation and review process, and terms and conditions of the HPRP to:

Inger Abrams Senior Program Officer Health Policy Research Program Research Management & Dissemination Division Health Canada Tel: (613) 952-8112 Fax: (613) 954-7363 Email: Inger_Abrams@hc-sc.gc.ca

VI. References

¹ Fields MJ, Cassel CK, eds, Committee on Care at the End of Life, Division of Health Care Services, Institute of Medicine. Approaching Death: Improving Care at the End of Life. Washington, D.C., National Academy Press, 1997.

² Ferris FD, Balfour HM, Farley J, Hardwick M, Lamontagne C, Lundy M. Syme A, West P. 2001 Proposed Norms of Practice for Hospice Palliative Care, Ottawa, ON: Canadian Palliative Care Association, 2001.