Looking Back, Moving Forward: A Retrospective Review of Care Trends in an Academic Palliative and Supportive Care Program from 2004-2015 (S744)

Abstract

•Relate the primary reasons palliative care consultations are ordered in an academic medical center.•Propose strategies for expanding palliative care in underserved areas. The University of Alabama at Birmingham (UAB) launched one of the first comprehensive PC programs in the U.S. in an area of the country with the lowest PC access. To examine UAB PC program trends from 2004-2015 to plan for future Southeast expansion. Retrospective electronic-record review of inpatient consultation, palliative care comfort unit (PCCU), and outpatient clinic trends. Inpatients (n=11,786) were on average 64 years old, male (50.1%), white (62.3%), with pulmonary, cardiac, or cancer diagnoses (45.0%) and referred primarily for goals of care discussions (83%). Between the 5-year time periods of 2004 (October)-10 and 2011-15, referral volumes increased from 5081 to 6705 and time from hospital admission to PC consult decreased from 9.3 to 7.8 days. Nearly half (47%) of consult inpatients were transferred to PCCU for an average of 5 days. Individuals transferred to PCCU tended to be older, female, and white, although one-third of PCCU patients were black. Top PCCU discharge dispositions were death (52.2%; n=2888), and home with hospice (21.3%; n=1179). Outpatients (n=315) were younger, female (63.5%), white (76.8%) with a cancer diagnosis (75.1%). Most outpatients presented with pain (64.8%) and over a quarter (27.3%) had moderately severe/severe depression. Symptoms with the highest severity reported by outpatients were fatigue, disturbed sleep, and pain. The UAB PC service model has demonstrated robust growth in consultations since inception, served a substantial number of racially diverse in- and outpatients, and treated debilitating symptoms including pain, fatigue, and depression in community-dwelling individuals with serious illness.