Development of a Community-Based Hospital Care Center Service System for End of Life Care in Maha Sarakham Province

Abstract

This action research aimed to develop and evaluate the community-based hospital care center service system for end-of-life care in Maha Sarakham Province. The service system was developed collaboratively by a multidisciplinary team based on the World Health Organization's guidelines: "6 Building Blocks of a Health System." The research period was December 2023 - March 2025. The system development was evaluated based on the outcomes of end-of-life care for 2,186 patients at the community-based hospital care center. Quantitative data were analyzed using descriptive statistics, including counts and percentages. Content analysis was used for qualitative data.

The results of the study revealed that the community-based hospital care center service system for end-of-life care was developed. Maha Sarakham Province consists of 1) organizing a system to support the provision of care services by driving operations through provincial and district level committees, managing life care centers according to standards, organizing a system to support resources and medical equipment; 2) managing an efficient care system with a Project Manager and Case Manager: CM (Palliative Care Nurse) to coordinate, develop and link the entire system. Develop care guidelines, CPG manuals, media, LINE groups, a consulting system, a referral system, and an information system, along with integrating technology into care. 3) Develop human resources based on the competencies of each profession, both within hospitals and within professional nurses in subdistrict health promotion hospitals. This includes developing village health volunteers (VHVs) and family caregivers to enhance their capacity to provide continuous care at home. Evaluation revealed that Maha Sarakham Province has established and opened community hospital lifecare centers that meet the standard criteria in all 12 districts 100%,100% of the multidisciplinary team's competency was developed, with 96.75% of families participating in family meetings. High-quality advance care planning was provided for palliative care patients 89.20% and for patients with the good death 93.45%.

Conclusion: The development of a community-based hospital lifecare center service system for end-of-life care, developed through participation and using the Six Building Blocks of a Health System as a guideline, has resulted in efficient service delivery that addresses the needs of end-of-life care and adequately allocates resources. This results in patients having access to comprehensive care services that cover their body, mind and spirit, appropriately until the end of life.