About the program
The Silverchain Community Palliative Care Service provided enhanced community-based palliative care to people in Western Sydney Local Health District (WSLHD).
Silverchain’s model of care was designed to provide 24 hours, 7 days a week on-call specialist palliative care services at home, including practical support for daily activities, support for families and carers and bereavement support. The community-based service aimed to improve the quality of life for people during their last phase of life and to support them to die in the place of their choice.
Services were delivered by multidisciplinary teams led by a case coordinator to provide care and support to patients and their families.
The service supported patients with an advanced and life-limiting illness from 2017 to 2024.
Where we are now
Silverchain supported 6,091 people over its 7-year service delivery period. Participants' total hospital use while in the program was less than their matched control group's usage by 8,105 National Weighted Activity Units. Results were statistically significant in Years 4 to 7.
At the end of the program, community palliative care services transitioned to the Western Sydney Local Health District.
Key learnings
Sufficient time, stakeholder engagement and adapting to local context is critical to successful implementation.
The Silverchain program was based on the service provider’s existing palliative care service operating in Western Australia. However, modifications were required for local context including how patients, referring clinicians and other stakeholders engaged with the program. Ongoing adaptations of the service delivery, staffing and referral processes were also required as different demands and challenges were faced, compared to the service in Western Australia.
Earlier acceptance of the new service would have been supported by more in-depth stakeholder consultation in the development and early implementation phase.
Silverchain and WSLHD made intentional changes to improve the service, including setting up a Palliative Care Partners group who met regularly, and collaborated on quality and safety processes, hospital discharge planning and education sessions. These contributed to strengthening relationships to deliver improvements and outcomes for patients.
Allow flexibility to refine metrics for better attribution of program impact
The original outcome payment metric was based on Silverchain’s Western Australia palliative care service model, assuming participants would join the program about three months before death. To simplify measurement, hospital usage was tracked for the last three months of each participant’s life.
Annual performance reviews were conducted to understand program effectiveness and explore improvements. By Year 3, data showed that most clients were either in the program for more than 6 months or less than 2 months, which introduced the following challenges in measuring the program's effectiveness:
- for participants who stayed in the program for over 6 months: the metric captured hospital use only during their final 3 months, missing the full impact of the program
- for participants who stayed in the program for less than 2 months: the metric included hospital use when they weren't in the program, distorting results.
To improve accuracy and precision, the metric was revised to measure hospital use over the actual time each participant spent in the program.
The process for selecting control group members was also refined to ensure the group more closely matched Silverchain participants on key characteristics.