title: CARE Track for Advanced Cancer: Impact and Timing of an Outpatient Palliative Care Clinic.
abstract: BACKGROUND
  Studies suggest that outpatient palliative care can reduce hospitalization and increase hospice utilization for patients with cancer, however there are insufficient resources to provide palliative care to all patients from time of diagnosis. It is also unclear whether inpatient consultation alone provides similar benefits. A better understanding of the timing, setting, and impact of palliative care for patients with cancer is needed.
  
  
  OBJECTIVE
  The purpose of this study was to measure timing of referral to outpatient palliative care and impact on end-of-life (EOL) care.
  
  
  METHODS
  The Comprehensive Assessment with Rapid Evaluation and Treatment (CARE Track) program is a phased intervention integrating outpatient palliative care into cancer care. In Year 1 patients were referred at the discretion of their oncologist.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  We compared EOL hospitalization, hospice utilization, and costs of care for CARE Track patients compared to those never seen by palliative care or seen only in hospital.
  
  
  RESULTS
  Patients were referred a median of 72.5 days prior to death. CARE Track patients had few hospitalizations at end of life, were less likely to die in hospital, had increased hospice utilization, and decreased costs of care; these results were significant even after controlling for differences between groups. Inpatient consultation alone did not impact these variables. However, only approximately half of patients with incurable cancers were referred to this program.
  
  
  CONCLUSIONS
  Referral outpatient palliative care within 3 months of death improved EOL care and reduced costs, benefits not seen with inpatient care only. However, many patients were never referred, and methods of systematically identifying appropriate patients are needed.
authors.affiliation: 1 Department of Palliative Care, University of Virginia , Charlottesville, Virginia.|2 Department of Internal Medicine, University of Virginia , Charlottesville, Virginia.
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Blackhall
authors.affiliation: 3 Department of Public Health Sciences, University of Virginia , Charlottesville, Virginia.
authors.forename: Paul
authors.initials: P
authors.lastname: Read
authors.affiliation: 4 Department of Health Services Research, University of Virginia , Charlottesville, Virginia.
authors.forename: George
authors.initials: G
authors.lastname: Stukenborg
authors.affiliation: 5 Department of Medical Oncology, University of Virginia , Charlottesville, Virginia.
authors.forename: Patrick
authors.initials: P
authors.lastname: Dillon
authors.affiliation: 2 Department of Internal Medicine, University of Virginia , Charlottesville, Virginia.
authors.forename: Joshua
authors.initials: J
authors.lastname: Barclay
authors.affiliation: 5 Department of Medical Oncology, University of Virginia , Charlottesville, Virginia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Romano
authors.affiliation: 3 Department of Public Health Sciences, University of Virginia , Charlottesville, Virginia.
authors.forename: James
authors.initials: J
authors.lastname: Harrison
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010045:Outpatients / Q000523:psychology* / Q000706:statistics & numerical data; D010166:Palliative Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States