MDS Project Data Entry Forms 2007/08

3. Home Care/Community Based Service

A home care patient is one who receives care from a professional member of a specialist palliative care service in their place of residence. Do not include those who only receive visits from volunteers, or the loan of equipment for home use.

Hospice at Home Teams: Please read instructions provided in the 'Notes for Completion of MDS Forms' by clicking here.

Please answer for the year 1/4/2007 to 31/3/2008.

All fields marked with * are mandatory. Use Tab Key or mouse to navigate through the fields. Do not use the Enter/Return key.

Enter your Data Set (MDS) Number here:*
(If you do not know your Data Set Number, please e-mail: mds@ncpc.org.uk giving your organisation name and postcode)

Organisation Name:*

If the service began during this period, give the date of opening here:

3.1	All patients
	Give the total number of patients registered as receiving home care from a health care professional (see above) during the year, whether new or existing referrals. Count each patient only once. (This number can be obtained from the number of new patients plus those seen for the first time during the year who were first registered in a previous year)

3.2	New patients - total
	Give the number of new home care patients, i.e. those who received home care for the first time ever during the year.

3.3	New patients - analysis
	Now give the number of new patients (adding up to 3.2 above) in these categories:

	a) Age on registration and sex	Female	Male	All
	Under 16 years
	16 to 24 years
	25 to 64 years
	65 to 74 years
	75 to 84 years
	85 years and over
	Not known
	All

	b) Primary diagnosis
	Cancer/malignant diagnosis
	HIV disease/AIDS
	Other non-cancer diagnoses
	Not known

	c) Referral to home care at diagnosis or later
	At first diagnosis (even if advanced disease)
	Some time after diagnosis

Please check that each section of 3.3 totals to the figure you gave in 3.2 above

	d) Reasons for referral
	Pain/symptom control
	Emotional/psychological support
	Social/financial
	Assessment for hospice admission
	Carer support
	Other

More than one reason may be given - totals will not add to figure given in 3.2

3.4	Telephone contacts
	If your service keeps a record of telephone contacts, give the total number of telephone calls to or from home care patients or their carers.

3.5	Home care visits ­ total
	Give the total number of home care visits by staff to patients during the year.

3.6	Home care visits ­ analysis
	Give the number of home care visits by staff to patients (adding up to 3.5 above) categorised according to the main staff member for each contact
	Clinical nurse specialist
	Other registered nurse
	Nursing auxiliary or care assistant
	Social worker or counsellor
	Doctor
	Allied Health Professionals
	Other

3.7	Deaths and discharges
	a) Deaths: Give the total number of patients during the year who died while registered as a home care patient
	b) Discharges: Give the number of discharges from home care during the year, i.e. periods of home care which ended other than with the patient's death
	c) Patients who died - analysis: Give the number of patients who died by place of death:
	At home
	Hospice/Specialist palliative care unit
	Hospital
	Other
	Not known

Please check that the numbers given in 3.7c total to the number of deaths given in 3.7a

3.8	Length of care episode
	Give the number of completed periods of home care (adding up to 3.7a+b above) categorised according to the time from first visit to death or discharge
	less than 2 weeks
	2 weeks up to 1 month
	1 up to 2 months
	2 up to 3 months
	3 up to 4 months
	4 up to 5 months
	5 up to 6 months
	6 months and over

	i)   Give the average (mean) length of period of home care, defined as the average time in days from first visit to death or discharge
	ii)  Give the number of patients (out of the total given in 3.1 above) who received home care throughout the whole year, i.e. were already receiving home care on 1/4/2007 and were still receiving care (not discharged/died) on 31/3/2008.

3.9	Staffing
	Give the number of whole time equivalent (WTE) staff employed in your home care team. If the number has varied during the course of the year please calculate the average. Do not include other professionals who are not employed as part of the team.
	Clinical nurse specialist
	Other registered nurse
	Nursing auxiliary or care assistant
	Doctor
	Social Worker
	Allied Health Professionals
	Other

	Does this form record the work of the whole team or only some of the above staff? Please give details.

Please add any comments

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