title: Clinic-based outpatient palliative care before hospice is associated with longer hospice length of service.
abstract: BACKGROUND
  Outpatient nonhospice palliative care has been shown to provide many benefits to patients facing advanced illness, but such services remain uncommon in the U.S. Little is known about the association between clinic-based outpatient palliative care consultation and the timing of hospice enrollment.
  
  
  OBJECTIVE
  To determine whether there are differences in hospice length of service (LOS) between patients who were seen vs. patients who were not seen in an outpatient palliative care clinic before enrollment in hospice.
  
  
  METHODS
  Using a retrospective study of medical records, a "prior palliative care clinic" group was formed of those hospice patients who had had a nonhospice clinic-based outpatient palliative care consult before hospice admission (n = 354). For those patients, "control" hospice patients without prior clinic-based palliative care were chosen who were matched by age, gender, median income of their zip code, and diagnostic group. Both groups were restricted to patients who died while enrolled in hospice. LOS for these two groups was compared using standard statistical methods of survival analysis.
  
  
  RESULTS
  Prior palliative care clinic patients had a median LOS of 24 days, whereas control patients had a median LOS of 15 days (95% CI for difference between the medians 5-13 days). The difference between the LOS distribution curves was statistically significant by the log-rank test (P < 0.001).
  
  
  CONCLUSIONS
  Hospice patients who had clinic-based outpatient palliative consults before hospice enrollment tended, on average, to have a longer LOS in hospice than patients who did not.
authors.affiliation: Capital Caring, Falls Church, Virginia, USA. Electronic address: cscheffey@capitalcaring.org.
authors.forename: Carl
authors.initials: C
authors.lastname: Scheffey
authors.affiliation: Capital Caring, Falls Church, Virginia, USA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Kestenbaum
authors.affiliation: Capital Caring, Falls Church, Virginia, USA; Veterans Affairs Healthcare System, Boston, Massachusetts, USA.
authors.forename: Melissa W
authors.initials: MW
authors.lastname: Wachterman
authors.affiliation: Capital Caring, Falls Church, Virginia, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Connor
authors.affiliation: Pain Research Center, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Perry G
authors.initials: PG
authors.lastname: Fine
authors.affiliation: Capital Caring, Falls Church, Virginia, USA.
authors.forename: Malene S
authors.initials: MS
authors.lastname: Davis
authors.affiliation: Capital Caring, Falls Church, Virginia, USA.
authors.forename: J Cameron
authors.initials: JC
authors.lastname: Muir
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D010166:Palliative Care / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D015995:Prevalence; D014768:Virginia / Q000453:epidemiology
keywords: Palliative clinic; hospice; length of service; outpatient palliative care