title: A statewide survey of adult and pediatric outpatient palliative care services.
abstract: BACKGROUND
  Outpatient palliative care services can improve patient outcomes, yet little is known about their structure and characteristics.
  
  
  OBJECTIVE
  To describe the structure and characteristics of outpatient palliative care services associated with California hospitals.
  
  
  METHODS
  Electronic survey.
  
  
  METHODS
  All 377 acute care hospitals in California.
  
  
  METHODS
  Outpatient palliative care services structure and operational characteristics, including staffing, clinical availability, and funding.
  
  
  RESULTS
  Overall 96% (361/377) of hospitals responded. Of the 136 hospitals with an adult palliative care service, 18% (n=24) reported an outpatient palliative care service with a mean age of 3.7 years. Of the 42 hospitals offering pediatric palliative care services, 19% (n=8) reported an outpatient palliative care service with a mean age of 3.4 years. On average, adult outpatient palliative care services see 159 new patients per year with 722 follow-up visits. Pediatric outpatient palliative care services see 10 new patients per year with 28 follow-up visits. The average staffing of adult outpatient palliative care services is 2.1 full-time equivalent (FTE; range, 0.2-12) and for pediatric outpatient palliative care services 0.7 FTE (range, 0.1-2.0). Adult outpatient palliative care services operate a mean of 3.9 days per week compared to 1.1 days per week for pediatric outpatient palliative care services. Few services provided 24/7 coverage (25% adult, 38% pediatric). Wait times for newly referred patients were 11 days for adults and 9 days for pediatrics. Most referrals are received from oncology (adult=47%, pediatric=43%). Funding for outpatient palliative care services is largely through institutional support (adult=80%, pediatric=62%), followed by foundations (adult=10.3%, pediatric=23%), billing (adult=8.8%, pediatric=0%), and philanthropy (adult=0.9%, pediatric=15%). Compared to similar data from 2007, the prevalence of outpatient palliative care services affiliated with hospitals in California has not changed significantly.
  
  
  CONCLUSIONS
  Few California hospitals offer outpatient palliative care services. This finding has remained consistent over time. Adult and pediatric outpatient palliative care services care primarily for patients with cancer, operate part-time with modest staffing, and are funded primarily by their institution. Making the case for value to engender more institutional support, increasing billing revenue, system initiatives, and partnering with insurers may lead to the establishment of more outpatient palliative care services.
authors.affiliation: 1 Division of General Internal Medicine, Department of Medicine, University of California , San Francisco, San Francisco, California.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rabow
authors.forename: David L
authors.initials: DL
authors.lastname: O'Riordan
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Pantilat
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D002140:California; D019538:Health Care Surveys; D006801:Humans; D010166:Palliative Care / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling; D000078329:Workforce