title: Comparing Unmet Needs to Optimize Quality: Characterizing Inpatient and Outpatient Palliative Care Populations.
abstract: Palliative care (PC) consultation services are available in most hospitals; outpatient services are rapidly growing to meet the needs of patients at earlier stages of the disease trajectory.
  
  
  
  We aimed to compare the unmet needs of PC patients by location of care to better characterize these populations.
  
  
  
  This cross-sectional secondary analysis examined patients receiving hospital and outpatient-based PC across 10 community and academic organizations in the Global Palliative Care Quality Alliance. We identified unmet symptom, advance care planning, and functional needs within our database from October 23, 2012 to January 22, 2015. Kruskal-Wallis, chi-square, and Fisher exact tests were performed.
  
  
  
  We evaluated 633 unique patients. Inpatients (n = 216) were older than outpatients (n = 417; 73 vs. 64 years, P < 0.0001). Seventy-six inpatients (38%) had a Palliative Performance Scale score ≤30%; no outpatients did (P < 0.0001). More inpatients rated their quality of life as poor compared with outpatients (39% vs. 21%, P = 0.0001). We found that outpatients presented with more unresolved pain than inpatients (58.5% vs. 4.1%, P < 0.0001). Conversely, more inpatients presented with unresolved anorexia (52.3% vs. 35.8%, P = 0.002) and dysphagia (28.1% vs. 5.4%, P < 0.0001) than outpatients. We found that inpatient setting was independently associated with lower performance status (odds ratio = 0.068, 95% confidence interval = 0.038-0.120, P < 0.0001).
  
  
  
  Compared with inpatients, outpatients are more burdened by pain at first PC encounter yet experience higher quality of life and better performance status. These findings suggest different clinician skillsets, and assessments are needed depending on the setting of PC consultation.
authors.affiliation: Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hochman
authors.affiliation: Duke Biostatistics Core, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Wolf
authors.affiliation: Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Syed Yousuf
authors.initials: SY
authors.lastname: Zafar
authors.affiliation: Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Portman
authors.affiliation: Four Seasons Compassion for Life, Hendersonville, North Carolina, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Bull
authors.affiliation: Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA; Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA. Electronic address: arif.kamal@duke.edu.
authors.forename: Arif H
authors.initials: AH
authors.lastname: Kamal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010045:Outpatients; D010166:Palliative Care; D011787:Quality of Health Care; D011788:Quality of Life; D012042:Registries; D055815:Young Adult
keywords: Palliative care; health care delivery; health care resources; outpatient clinics; symptom assessment