title: Do palliative consultations improve patient outcomes?
abstract: OBJECTIVE
  To determine whether inpatient palliative consultation services improve outcomes of care.
  
  
  METHODS
  Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life.
  
  
  METHODS
  Five VA Medical Centers or their affiliated nursing homes and outpatient clinics.
  
  
  METHODS
  Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey.
  
  
  METHODS
  The telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well-being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items).
  
  
  RESULTS
  Interviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62-66) versus 54 (95% CI=51-56; P<.001) and higher scores for almost all domains. Earlier consultations were independently associated with better overall scores (beta=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support.
  
  
  CONCLUSIONS
  Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit.
authors.affiliation: Center for Health Equity Research and Promotion, Department of Veterans Affairs, Philadelphia, Pennsylvania, USA. Casarett@mail.med.upenn.edu
authors.forename: David
authors.initials: D
authors.lastname: Casarett
authors.forename: Amy
authors.initials: A
authors.lastname: Pickard
authors.forename: F Amos
authors.initials: FA
authors.lastname: Bailey
authors.forename: Christine
authors.initials: C
authors.lastname: Ritchie
authors.forename: Christian
authors.initials: C
authors.lastname: Furman
authors.forename: Ken
authors.initials: K
authors.lastname: Rosenfeld
authors.forename: Scott
authors.initials: S
authors.lastname: Shreve
authors.forename: Zhen
authors.initials: Z
authors.lastname: Chen
authors.forename: Judy A
authors.initials: JA
authors.lastname: Shea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital; D010045:Outpatients; D010166:Palliative Care / Q000379:methods*; D017060:Patient Satisfaction; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States