title: Does a palliative care clinic have a role in improving end-of-life care? Results of a pilot program.
abstract: OBJECTIVE
  To assess the efficacy of a palliative care clinic (PCC), which provided some of the interdisciplinary services and expertise of an inpatient consult service to outpatients, in traditional clinic sessions.
  
  
  METHODS
  Chart review.
  
  
  METHODS
  A large urban Veterans Administration Medical Center.
  
  
  METHODS
  One hundred patients referred to clinic.
  
  
  METHODS
  Palliative care clinic.
  
  
  METHODS
  Patients' reported needs, Global Distress Index (GDI) subscale, hospice eligibility, and time to death.
  
  
  RESULTS
  The most common diagnosis was cancer (n = 85). Most patients (n = 89) had at least one need for services that the team provided (median, 2; range, 0-4), the most common of which was a desire for information about prognosis (n = 84). In a Cox proportional hazards model, predictors of enrollment in hospice included white ethnicity (hazard ratio, 3.42; p < 0.001), a need for help around the home (hazard ratio, 3.26; p = 0.002), and insufficient money left at the end of the month (hazard ratio, 2.39; p = 0.014).
  
  
  CONCLUSIONS
  The experience of the PCC described here offers a unique approach to improving end-of-life care for those outpatients who may not be well served by existing structures of care such as palliative care consult services and who have not yet enrolled in hospice.
authors.affiliation: Philadelphia Veterans Affairs Medical Center and Department of Medicine, Institute on Aging, University of Pennsylvania, 19104, USA. casarett@mail.med.upenn.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Casarett
authors.forename: Karen B
authors.initials: KB
authors.lastname: Hirschman
authors.forename: John F
authors.initials: JF
authors.lastname: Coffey
authors.forename: Lucy
authors.initials: L
authors.lastname: Pierre
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care / Q000379:methods / Q000639:trends; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D010166:Palliative Care / Q000379:methods / Q000458:organization & administration* / Q000639:trends; D010865:Pilot Projects; D016730:Program Development; D015397:Program Evaluation; D016016:Proportional Hazards Models; D016019:Survival Analysis; D014481:United States