title: A High-Touch Model of Community-Based Specialist Palliative Care: Latent Class Analysis Identifies Distinct Patient Subgroups.
abstract: Community-based palliative care may support seriously ill homebound patients. Programs vary widely, and few studies have described the heterogeneity of the populations served or service delivery models.
  
  
  
  To evaluate a diverse population served by an interdisciplinary model of community-based specialist palliative care and the variation in service delivery over time and identify subgroups with distinct illness burden profiles.
  
  
  
  A retrospective cohort study evaluated longitudinal electronic health record data from 894 patients served during 2010-2013. Illness burden was defined by measures of performance status (Karnofsky Performance Status scale), symptom distress (Condensed Memorial Symptom Assessment Scale), palliative care needs (Palliative Outcome Scale), and quality of life (Spitzer Quality of Life Index). Service utilization included the frequency of visits received and calls made or received by patients. Latent class analysis identified patient subgroups with distinct illness burden profiles, and mixed-effects modeling was used to evaluate associations between patient characteristics and service utilization.
  
  
  
  The mean age was 72.3 years (SD = 14.0); 56.2% were women; 67.5% were English speaking; and 22.2% were Spanish speaking. Most had congestive heart failure (36.4%) or cancer (30.4%); 98.0% had a Karnofsky Performance Status score of 40-70. Four patient subgroups were identified: very low illness burden (26.2%); low burden (39.5%); moderate burden (13.5%); and high burden (20.8%). The subgroups differed in both baseline characteristics and palliative care service utilization over time.
  
  
  
  The population served by a community-based specialist palliative care program manages patients with different levels of illness burden, which are associated with patient characteristics and service utilization.
authors.affiliation: MJHS Institute for Innovation in Palliative Care, New York, New York, USA. Electronic address: LDhingra@mjhs.org.
authors.forename: Lara
authors.initials: L
authors.lastname: Dhingra
authors.affiliation: School of Nursing and School of Medicine, Oregon Health & Science University, Portland, Oregon, USA; Decision Research, Eugene, Oregon, USA.
authors.forename: Nathan F
authors.initials: NF
authors.lastname: Dieckmann
authors.affiliation: MJHS Institute for Innovation in Palliative Care, New York, New York, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Helena
authors.initials: H
authors.lastname: Knotkova
authors.affiliation: MJHS Institute for Innovation in Palliative Care, New York, New York, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Chen
authors.affiliation: MJHS Institute for Innovation in Palliative Care, New York, New York, USA.
authors.forename: Alexa
authors.initials: A
authors.lastname: Riggs
authors.affiliation: MJHS Institute for Innovation in Palliative Care, New York, New York, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Brenda
authors.initials: B
authors.lastname: Breuer
authors.affiliation: MJHS Hospice and Palliative Care, New York, New York, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hiney
authors.affiliation: Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Bernard
authors.initials: B
authors.lastname: Lee
authors.affiliation: The Center for Hospice & Palliative Care, New York, New York, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: McCarthy
authors.affiliation: MJHS Institute for Innovation in Palliative Care, New York, New York, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA; MJHS Hospice and Palliative Care, New York, New York, USA.
authors.forename: Russell
authors.initials: R
authors.lastname: Portenoy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care; D057286:Electronic Health Records; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D017567:Karnofsky Performance Status; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010342:Patient Acceptance of Health Care; D011788:Quality of Life; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult
keywords: Community-based palliative care; health services utilization; illness burden; interdisciplinary care models; latent class analysis; specialist care