Initiating Home Diagnostic Assessment Tools for Point of Care Testing in Community Supportive & Palliative Care Patients to Facilitate Care at Home in Life-Limiting End-of-Life conditions
Velindre University NHS Trust & Cardiff and Vale University Health Board
Introduction:
This project aimed to enhance value-based, person-centred care for patients with life-limiting conditions, particularly interstitial lung disease (ILD), by introducing point-of-care testing (POCT) in community palliative care settings. The goal was to reduce unnecessary hospital admissions and align care with patient preferences to remain at home during end-of-life.
Methods:
The pilot introduced home-based POCT, specifically C-reactive protein (CRP) testing using portable devices. Baseline and symptom-triggered tests were performed in patients’ homes, clinics, and care homes. The initiative followed Plan-Do-Study-Act (PDSA) cycles, focusing on feasibility, clinical use, feedback, and expansion. The intervention was co-designed with clinicians and supported by Value in Health and the health board POCT team. Evaluation included clinical outcomes, staff/patient feedback, and financial impact.
Outcomes:
- 61% reduction in inappropritate hospital admissions and bed days and deaths in hospital fell to 51%.
- £107,000 estimated annual savings
- 83% of symptomatic patients did not require antibiotics after POCT.
- Improved patient/carer satisfaction and staff decision-making confidence.
- Minimal added pressure on community services; reduced emergency admissions and hospital stays.
Learnings:
Co-design and early stakeholder engagement were vital. Device portability and simplified data capture were identified as improvement areas. Governance structures ensured safety and quality. Scalability is feasible with ongoing support.
What next?
The project will expand to other disease cohorts (heart, liver, renal failure) and settings, integrating POCT into routine care. Additional portable devices and biomarkers are being explored. A broader rollout across Wales is planned, with continued evaluation and potential for national adoption aligned with the Duty of Quality and value-based care goals.
