Abstract
1.Describe the current landscape of outpatient palliative care services available at California hospitals2.Review the typical outpatient service structure and characteristics3.Highlight differences between adult and pediatric outpatient palliative care practices Outpatient palliative care services (OPCS) can improve patient outcomes, yet little is known about their structure and characteristics. To describe the structure and characteristics of OPCS associated with California hospitals. We surveyed all 377 hospitals in California regarding the structure and characteristics of palliative care services (PCS). Overall 361/377 (96%) hospitals responded. Of the 136 hospitals with an adult PCS, 18% (n = 24) have an OPCS. Of the 42 hospitals offering pediatric PCS, 19% (n = 8) have an OPCS. On average, adult OPCS see 159 new patients per year (mean visit length 65 minutes) with 721 follow up visits (mean length 37 minutes). Pediatric OPCS see 10 new patients per year (mean visit length 60 minutes) with 28 follow up visits (mean length 32 minutes). The average staffing of adult OPCS is 2.7 FTE (range: 0.1-14.7) and for pediatric OPCSs 1.5 FTE (range: 0.1-4.0). Adult OPCS operate a mean of 3.9 days/week compared to 1.1 days/week for pediatric OPCS. Few services provided 24/7 coverage (25% adult, 38% pediatric). Wait times for newly referred patients were 10.7 days for adults and 8.7 days for pediatrics. Most referrals are received from oncology (Adult = 47%, Pediatric = 43%), the inpatient PCS (Adult = 27%, Pediatric = 16%), or primary care (Adult = 12%, Pediatric = 4%). Funding for OPCS is largely through institutional support (Adult = 80.0%, Pediatric = 62.0%), followed by foundations (Adult = 10.3%, pediatric = 23.0%), billing (Adult = 8.8%, Pediatric = 0%), and philanthropy (Adult = 0.9%, Pediatric = 15.0%). Few California hospitals offer OPCS, though one-fifth offering inpatient PCS also offer OPCS. OPCS care primarily for cancer patients, operate part-time with modest staffing, and are funded primarily by their institution.
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