title: The Prevalence of Inpatients at 33 U.S. Hospitals Appropriate for and Receiving Referral to Palliative Care.
abstract: BACKGROUND
  The extent of unmet need for palliative care in U.S. hospitals remains largely unknown. We conducted a multisite cross-sectional, retrospective point prevalence analysis to determine the size and characteristics of the population of inpatients at 33 U.S. hospitals who were appropriate for palliative care referral, as well as the percentage of these patients who were referred for and/or received palliative care services. We also conducted a qualitative assessment of barriers and facilitators to referral, focusing on organizational characteristics that might influence palliative care referral practices.
  
  
  METHODS
  Patients appropriate for palliative care referral were defined as adult (≥18 years) patients with any diagnosis of a poor-prognosis cancer, New York Heart Association class IV congestive heart failure, or oxygen-dependent chronic obstructive pulmonary disease who had inpatient status in 1 of 33 hospitals on May 13, 2014. Qualitative assessment involved interviews of palliative care team members and nonpalliative care frontline providers.
  
  
  RESULTS
  Nearly 19% of inpatients on the point prevalence day were deemed appropriate for palliative care referral. Of these, approximately 39% received a palliative care referral or services. Delivery of palliative care services to these patients varied widely among participating hospitals, ranging from approximately 12% to more than 90%. Factors influencing differences in referral practices included nonstandardized perceptions of referral criteria and variation in palliative care service structures.
  
  
  CONCLUSIONS
  This study provides useful information to guide providers, administrators, researchers, and policy experts in planning for optimal provision of palliative care services to those in need.
authors.affiliation: 1 Member Relations and Insights, University HealthSystem Consortium (UHC), Chicago, Illinois.
authors.forename: Marilyn K
authors.initials: MK
authors.lastname: Szekendi
authors.affiliation: 1 Member Relations and Insights, University HealthSystem Consortium (UHC), Chicago, Illinois.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Vaughn
authors.affiliation: 2 Department of Palliative Care, Roswell Park Cancer Institute , Buffalo, New York.
authors.forename: Ashima
authors.initials: A
authors.lastname: Lal
authors.affiliation: 3 Department of Emergency Medicine, Brigham & Women's Hospital , Boston, Massachusetts.
authors.forename: Kei
authors.initials: K
authors.lastname: Ouchi
authors.affiliation: 4 Center for Health Services Research, University of Kentucky , Lexington, Kentucky.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand; D006333:Heart Failure / Q000628:therapy; D006761:Hospitals; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D010166:Palliative Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States