title: Integrating palliative care into the outpatient, private practice oncology setting.
abstract: BACKGROUND
  Quality care for patients with cancer is a national priority-for those with noncurable cancer, the stakes are even higher. Strategies to promote integration of palliative care into oncology practice may enhance quality. We have developed a model in which palliative care services are integrated into the private, office-based oncology practice setting. We have evaluated the feasibility and assessed outcomes for both the oncologists and the patients they serve. To our knowledge, an embedded clinic in an outpatient, private practice oncology clinic has not been described previously.
  
  
  OBJECTIVE
  The primary outcomes assessed were 1) quality care outcomes through assessment of symptom burden and relief achieved through palliative care consultation, 2) provider satisfaction, 3) volume determined by number of palliative care consultations over time, and 4) time saved for the oncologist as a surrogate for the bottom line of the cancer practice.
  
  
  METHODS
  Measurement of: symptom burden and relief with the Edmonton Symptom Assessment System (ESAS), physician acceptance of palliative care services through a provider satisfaction survey and volume of referrals, and billing data to determine potential oncologists' time saved.
  
  
  RESULTS
  Palliative care consultation was associated with a reduction in symptom burden by 21%, evidenced by decrease in average total ESAS score from 49.3 to 39. Median provider satisfaction scores rating components of palliative care ranged from 8.5 to 9/10, with an overall provider satisfaction of 9/10. Over the study period, the "embedded" oncology group consultation requests increased 87% (67-120), with each individual oncology provider nearly doubled. The total time saved for the oncology practice in Year 2 was just over four weeks (9720 minutes; 162 hours).
  
  
  CONCLUSIONS
  An embedded palliative care clinic integrated into an office-based oncology practice is feasible and may improve the quality of care. Formal study of this service delivery model is warranted.
authors.affiliation: Capital Hospice and Capital Palliative Care Consultants, Falls Church, Virginia 22042, USA. cmuir@capitalhospice.org
authors.forename: J Cameron
authors.initials: JC
authors.lastname: Muir
authors.forename: Farrah
authors.initials: F
authors.lastname: Daly
authors.forename: Malene S
authors.initials: MS
authors.lastname: Davis
authors.forename: Richard
authors.initials: R
authors.lastname: Weinberg
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Heintz
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Paivanas
authors.forename: Roy
authors.initials: R
authors.lastname: Beveridge
mesh_terms: D003695:Delivery of Health Care; D006801:Humans; D008495:Medical Oncology / Q000458:organization & administration*; D009369:Neoplasms / Q000628:therapy*; D010045:Outpatients; D010166:Palliative Care / Q000458:organization & administration*; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D011331:Private Practice; D011787:Quality of Health Care; D012017:Referral and Consultation; D016896:Treatment Outcome