title: Initiating pain and palliative care outpatient services for the suburban underserved in Montgomery County, Maryland: Lessons learned at the NIH Clinical Center and MobileMed.
abstract: With the ongoing expansion of palliative care services throughout the United States, meeting the needs of socioeconomically marginalized populations, as in all domains of healthcare, continues to be a challenge. Our specific aim here was to help meet some of these needs through expanding delivery of pain and palliative care services by establishing a new clinic for underserved patients and collecting descriptive data about its operation.
  
  
  
  In November of 2014, the National Institutes of Health Clinical Center's Pain and Palliative Care Service (PPCS) launched a bimonthly offsite pain and palliative care outpatient clinic in collaboration with Mobile Medical Care Inc. (MobileMed), a private not-for-profit primary care provider in Montgomery County, Maryland, serving underserved area residents since 1968. Staffed by NIH hospice and palliative medicine clinical fellows and faculty, the clinic provides specialty pain and palliative care consultation services to patients referred by their primary care healthcare providers. A patient log was maintained, charts reviewed, and referring providers surveyed on their satisfaction with the service.
  
  
  
  The clinic had 27 patient encounters with 10 patients (6 males, 4 females, aged 23-67) during its first 7 months of operation. The reason for referral for all but one patient was chronic pain of multiple etiologies. Patients had numerous psychosocial stressors and comorbidities. All primary care providers who returned surveys (n = 4) rated their level of satisfaction with the consultation service as "very satisfied" or "extremely satisfied."
  
  
  
  This brief descriptive report outlines the steps taken and logistical issues addressed to launch and continue the clinic, the characteristics of patients treated, and the results of quality-improvement projects. Lessons learned are highlighted and future directions suggested for the clinic and others that may come along like it.
authors.affiliation: Pain and Palliative Care Service,Clinical Center,National Institutes of Health,Bethesda,Maryland.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Aggarwal
authors.affiliation: Pain and Palliative Care Service,Clinical Center,National Institutes of Health,Bethesda,Maryland.
authors.forename: Amrita
authors.initials: A
authors.lastname: Ghosh
authors.affiliation: Pain and Palliative Care Service,Clinical Center,National Institutes of Health,Bethesda,Maryland.
authors.forename: M Jennifer
authors.initials: MJ
authors.lastname: Cheng
authors.affiliation: Mobile Medical Care Inc.,Bethesda,Maryland.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Luton
authors.affiliation: Mobile Medical Care Inc.,Bethesda,Maryland.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Lowet
authors.affiliation: Pain and Palliative Care Service,Clinical Center,National Institutes of Health,Bethesda,Maryland.
authors.forename: Ann
authors.initials: A
authors.lastname: Berger
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D017051:Hospice Care / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008396:Maryland; D008875:Middle Aged; D008952:Mobile Health Units / Q000458:organization & administration*; D009316:National Institutes of Health (U.S.); D010045:Outpatients; D059408:Pain Management / Q000379:methods*; D010166:Palliative Care / Q000458:organization & administration*; D017060:Patient Satisfaction; D019036:Suburban Health Services / Q000458:organization & administration*; D014481:United States; D055815:Young Adult
keywords: Maryland; Pain management; Palliative care; Suburbanization of poverty; Underserved