title: The diverse landscape of palliative care clinics.
abstract: BACKGROUND
  Many health care organizations are interested in instituting a palliative care clinic. However, there are insufficient published data regarding existing practices to inform the development of new programs.
  
  
  OBJECTIVE
  Our objective was to obtain in-depth information about palliative care clinics.
  
  
  METHODS
  We conducted a cross-sectional survey of 20 outpatient palliative care practices in diverse care settings. The survey included both closed- and open-ended questions regarding practice size, utilization of services, staffing, referrals, services offered, funding, impetus for starting, and challenges.
  
  
  RESULTS
  Twenty of 21 (95%) practices responded. Practices self-identified as: hospital-based (n=7), within an oncology division/cancer center (n=5), part of an integrated health system (n=6), and hospice-based (n=2). The majority of referred patients had a cancer diagnosis. Additional common diagnoses included chronic obstructive pulmonary disease, neurologic disorders, and congestive heart failure. All practices ranked "pain management" and "determining goals of care" as the most common reasons for referrals. Twelve practices staffed fewer than 5 half-days of clinic per week, with 7 operating only one half-day per week. Practices were staffed by a mixture of physicians, advanced practice nurses or nurse practitioners, nurses, or social workers. Eighteen practices expected their practice to grow within the next year. Eleven practices noted a staffing shortage and 8 had a wait time of a week or more for a new patient appointment. Only 12 practices provide 24/7 coverage. Billing and institutional support were the most common funding sources. Most practices described starting because inpatient palliative providers perceived poor quality outpatient care in the outpatient setting. The most common challenges included: funding for staffing (11) and being overwhelmed with referrals (8).
  
  
  CONCLUSIONS
  Once established, outpatient palliative care practices anticipate rapid growth. In this context, outpatient practices must plan for increased staffing and develop a sustainable financial model.
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA. aksmith@ucsf.edu
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Smith
authors.forename: Julie N
authors.initials: JN
authors.lastname: Thai
authors.forename: Marie A
authors.initials: MA
authors.lastname: Bakitas
authors.forename: Diane E
authors.initials: DE
authors.lastname: Meier
authors.forename: Lynn H
authors.initials: LH
authors.lastname: Spragens
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
authors.forename: David E
authors.initials: DE
authors.lastname: Weissman
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rabow
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006276:Health Facility Size; D006801:Humans; D010166:Palliative Care / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014481:United States; D000078329:Workforce