Understanding trajectories of illness and cohorts of need
Definition:
That the primary driver for support is the identification of need at an individual level, meaning that which is required, in the context of the last year of life, to enable people to achieve an acceptable level of quality of life.
To help in describing the type of needs that underpin the Functional Analysis undertaken by Skills for Health, which are based on these trajectories of need, you can download a series of individual descriptions of people in mind (link to appear).
Information:
The Cohort Model identifies:
- A percentage split in the trajectories of illness for a typical 200,000 population as reflected in the table below:
| Trajectory | Characteristics of the last year of life | Number of deaths (>18) in England (2009) |
| Sudden death |
Any deaths where there was no obvious prognosis until last days |
63,368 or 14% |
| Cancers |
Gradual decline and then rapid end stages but without previous exacerbations or sudden changes in need. |
94,264 or 21% |
| Other terminal |
Gradual decline with some exacerbations in initial phase of last year then rapid end stage |
19,490 or 4% |
| Organ failure |
One predominant chronic condition with regular or fairly frequent exacerbations and with end of life typically being the result of a crisis and therefore more rapid deterioration in functions. |
84,167 or 19% |
| Frailty |
Multiple co-morbidities accumulating with increasing age leading to a gradual decline and regular exacerbations before last days. |
192,977 or 42% |
- That the proportion of people whose needs reflect the frailty trajectory will increase over time due to improved treatments for other potentially life-threatening conditions.
The Y&H Commissioner Financial Model identifies:
- The actual cost of End of Life care for a cohort in the last 3,6, 9 or 12 months of life and potential future cost with no change in care pathways
- The estimated cost of care if support needs are identified and alternative care pathways used.
The Functional Analysis by end of life care trajectory work identifies the following in respect of delivering good quality care for individuals in the last year of life outside of an acute setting:
- The skills needed
- The level of skills
- The amount of time for this skill
How to use the models:
Use the Cohort Model to explore:
- The extent to which demographic changes shift the balance of End of Life care in a typical 200,000 population;
- The potential cohort of the frail elderly and consider, in the local context, where these people are currently supported (and by implication, already funded) including care homes, complex care management in the community and continuing NHS healthcare.
To use the Cohort Model in order to understand trajectories of illness and cohorts of need, follow the step-by-step guide in the Cohort Model tutorial .
Go to the Whole Systems Partnership Cohort Model
Use the Y&H Commissioner Financial Model to explore:
- How to stimulate local discussion about pathways to improved End of Life care.
Go to the Yorkshire and the Humber Co-design model (formerly known as the Yorkshire and Humber Commissioner Financial Model).
Use the Functional Analysis workbooks and narrative to explore:
- What assumptions have been included within the Cohort Model in respect of workforce
- How your local way of working compares and consider any significant deviations from the model that may need to be accounted for in its use.
Go to the Skills for Health Functional Analysis page.
Case Studies
Case studies illustrating possible applications for the tools:
Care-Plus Project in Tower Hamlets PCT and London Borough of Tower Hamlets