title: The optimal delivery of palliative care: a national comparison of the outcomes of consultation teams vs inpatient units.
abstract: BACKGROUND
  Growing attention to end-of-life care has led to intensive efforts to provide better palliative care. However, it is not known whether palliative care is best provided by consultative teams or in dedicated units.
  
  
  METHODS
  This nationwide telephone survey was conducted in 77 Veterans Affairs medical centers that offer palliative care consultation services and dedicated palliative care units. One family member per patient who died at a participating Veterans Affairs medical center between July 1, 2008, and December 31, 2009, was invited to participate. The telephone survey included 1 global rating item and 9 core items describing the patient's care in the last month of life.
  
  
  RESULTS
  Interviews were completed with family members for 5901 of 9546 patients. Of these, 1873 received usual care, 1549 received a palliative care consultation, and 2479 received care in a palliative care unit. After nonresponse weighting and propensity score adjustment, families of patients who received a palliative care consultation were more likely than those who received usual care to report that the patient's care in the last month of life had been "excellent" (adjusted proportions: 51% vs 46%; odds ratio [OR], 1.25; 95% confidence interval [CI], 1.02-1.55; P = .04). However, families of patients who received care in a palliative care unit were even more likely to report excellent care (adjusted proportions: 63% vs 53%; OR, 1.52; 95% CI, 1.25-1.85; P < .001).
  
  
  CONCLUSIONS
  Care received in palliative care units may offer more improvements in care than those achieved with palliative care consultations.
authors.affiliation: Division of Geriatric Medicine, School of Medicine, University of Pennsylvania, 3615 Chestnut St, Philadelphia, PA 19104, USA. Casarett@mail.med.upenn.edu
authors.forename: David
authors.initials: D
authors.lastname: Casarett
authors.forename: Megan
authors.initials: M
authors.lastname: Johnson
authors.forename: Dawn
authors.initials: D
authors.lastname: Smith
authors.forename: Diane
authors.initials: D
authors.lastname: Richardson
mesh_terms: D006757:Hospital Units / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D010166:Palliative Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011787:Quality of Health Care