Comparing Unmet Needs to Optimize Quality: Characterizing Inpatient and Outpatient Palliative Care Populations

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• 作者：Michael J. Hochman ; BS^a ; Steven Wolf ; MS^b ; Syed Yousuf Zafar ; MD ; MHS^a ; ^c ; Diane Portman ; MD^e ; Janet Bull ; MD^f ; Arif H. Kamal ; MD ; MBA ; MHS^a ; ^c ; ^d ; ^{arif.kamal@duke.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Palliative care ; health care delivery ; health care resources ; outpatient clinics ; symptom assessment
• 刊名：Journal of Pain and Symptom Management
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：51
• 期：6
• 页码：1033-1039.e3
• 全文大小：274 K

文摘

Palliative care (PC) consultation services are available in most hospitals; outpatient services are rapidly growing to meet the needs of patients at earlier stages of the disease trajectory.

Objectives

We aimed to compare the unmet needs of PC patients by location of care to better characterize these populations.

Methods

This cross-sectional secondary analysis examined patients receiving hospital and outpatient-based PC across 10 community and academic organizations in the Global Palliative Care Quality Alliance. We identified unmet symptom, advance care planning, and functional needs within our database from October 23, 2012 to January 22, 2015. Kruskal-Wallis, chi-square, and Fisher exact tests were performed.

Results

We evaluated 633 unique patients. Inpatients (n = 216) were older than outpatients (n = 417; 73 vs. 64 years, P < 0.0001). Seventy-six inpatients (38%) had a Palliative Performance Scale score ≤30%; no outpatients did (P < 0.0001). More inpatients rated their quality of life as poor compared with outpatients (39% vs. 21%, P = 0.0001). We found that outpatients presented with more unresolved pain than inpatients (58.5% vs. 4.1%, P < 0.0001). Conversely, more inpatients presented with unresolved anorexia (52.3% vs. 35.8%, P = 0.002) and dysphagia (28.1% vs. 5.4%, P < 0.0001) than outpatients. We found that inpatient setting was independently associated with lower performance status (odds ratio = 0.068, 95% confidence interval = 0.038–0.120, P < 0.0001).

Conclusion

Compared with inpatients, outpatients are more burdened by pain at first PC encounter yet experience higher quality of life and better performance status. These findings suggest different clinician skillsets, and assessments are needed depending on the setting of PC consultation.