Development of a community-based end-of-life care model using the concept of Hub and Spokes: Evaluation using historical control groups
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Abstract
BACKGROUND: Access to palliative care services in rural remains unequal and lacks continuity. Na Noi Hospital in Nan Province experienced low diagnostic rates for terminally ill patients and lacked an effective home-based care system. Therefore, the “Hub and Spoke” concept was applied, with the hospital serving as the central hub supporting primary healthcare networks.
OBJECTIVE: To investigate the current situation and develop a community-based palliative care model using the Hub and Spoke concept appropriate to the hospital context, and to compare the effectiveness of the new care model with the existing system.
METHODS: A mixed-methods research and development (R&D) study compared outcomes between an intervention group receiving the new care model during October 2025–January 2026 (n=63) and a historical control group from fiscal years 2023–2025 (n=63), matched using propensity score matching. The new care model included an automated alert system, network capacity building, establishment of a medical equipment support center, and pain management using syringe drivers. Data were analyzed using descriptive statistics, Chi-square tests, and t-tests, with statistical significance set at p<0.05.
RESULTS: Baseline characteristics between the two groups were not significantly different (p>0.05). After implementation of the new model, the diagnostic and registration rate for end-of-life care (ICD-10: Z51.5) increased from 16.3% to 30.6% (p<0.001). The intervention group had a higher rate of Advance Care Planning (ACP) than the control group (96.8% vs. 85.7%, p=0.030). Clinical outcomes showed positive trends in access to strong opioids (74.6% vs. 60.3%, p=0.086) and home deaths (23.1% vs. 6.7%, p=0.326). Caregiver satisfaction was very high in both groups and showed no significant difference (97.7% and 98.5%; p=0.158).
CONCLUSIONS AND RECOMMENDATIONS: The Hub and Spoke care model improved access to services and ACP. However, outcomes related to pain management and home death require longer-term studies to confirm statistical significance. Expansion of the automated alert system and network capacity building to other community hospitals is recommended.
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