Moving upstream: a review of the evidence of the impact of outpatient palliative care.
BACKGROUND
There is good evidence for the efficacy of inpatient palliative care in improving clinical care, patient and provider satisfaction, quality of life, and health care utilization. However, the evidence for the efficacy of nonhospice outpatient palliative care is less well known and has not been comprehensively reviewed.


OBJECTIVE
To review and assess the evidence of the impact of outpatient palliative care.


METHODS
Our study was a review of published, peer-reviewed outcomes research, including both observational studies and controlled trials of nonhospice outpatient palliative care services. We assessed patient, family caregiver, and clinician satisfaction; clinical outcomes including symptom management, quality of life, and mortality; and heath care utilization outcomes including readmission rates, hospice use, and cost.


RESULTS
Four well-designed randomized interventions as well as a growing body of nonrandomized studies indicate that outpatient palliative care services can: 1) improve patient satisfaction, 2) improve symptom control and quality of life, 3) reduce health care utilization, and 4) lengthen survival in a population of lung cancer patients.


CONCLUSIONS
The available evidence supports the ongoing expansion of innovative outpatient palliative care service models throughout the care continuum to all patients with serious illness.
1 Department of Internal Medicine, University of California , San Francisco, California.
Michael
M
Rabow
Elizabeth
E
Kvale
Lisa
L
Barbour
J Brian
JB
Cassel
Susan
S
Cohen
Vicki
V
Jackson
Carol
C
Luhrs
Vincent
V
Nguyen
Simone
S
Rinaldi
Donna
D
Stevens
Lynn
L
Spragens
David
D
Weissman
D000553:Ambulatory Care; D006801:Humans; D010166:Palliative Care / Q000523:psychology*; D017060:Patient Satisfaction; D011788:Quality of Life; D016896:Treatment Outcome