Skip to main content
Journal cover image

Comparing Unmet Needs to Optimize Quality: Characterizing Inpatient and Outpatient Palliative Care Populations.

Publication ,  Journal Article
Hochman, MJ; Wolf, S; Zafar, SY; Portman, D; Bull, J; Kamal, AH
Published in: J Pain Symptom Manage
June 2016

CONTEXT: 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. OBJECTIVES: We aimed to compare the unmet needs of PC patients by location of care to better characterize these populations. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Pain Symptom Manage

DOI

EISSN

1873-6513

Publication Date

June 2016

Volume

51

Issue

6

Start / End Page

1033 / 1039.e3

Location

United States

Related Subject Headings

  • Young Adult
  • Registries
  • Quality of Life
  • Quality of Health Care
  • Palliative Care
  • Outpatients
  • Odds Ratio
  • Multivariate Analysis
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hochman, M. J., Wolf, S., Zafar, S. Y., Portman, D., Bull, J., & Kamal, A. H. (2016). Comparing Unmet Needs to Optimize Quality: Characterizing Inpatient and Outpatient Palliative Care Populations. J Pain Symptom Manage, 51(6), 1033-1039.e3. https://doi.org/10.1016/j.jpainsymman.2015.12.338
Hochman, Michael J., Steven Wolf, Syed Yousuf Zafar, Diane Portman, Janet Bull, and Arif H. Kamal. “Comparing Unmet Needs to Optimize Quality: Characterizing Inpatient and Outpatient Palliative Care Populations.J Pain Symptom Manage 51, no. 6 (June 2016): 1033-1039.e3. https://doi.org/10.1016/j.jpainsymman.2015.12.338.
Hochman MJ, Wolf S, Zafar SY, Portman D, Bull J, Kamal AH. Comparing Unmet Needs to Optimize Quality: Characterizing Inpatient and Outpatient Palliative Care Populations. J Pain Symptom Manage. 2016 Jun;51(6):1033-1039.e3.
Hochman, Michael J., et al. “Comparing Unmet Needs to Optimize Quality: Characterizing Inpatient and Outpatient Palliative Care Populations.J Pain Symptom Manage, vol. 51, no. 6, June 2016, pp. 1033-1039.e3. Pubmed, doi:10.1016/j.jpainsymman.2015.12.338.
Hochman MJ, Wolf S, Zafar SY, Portman D, Bull J, Kamal AH. Comparing Unmet Needs to Optimize Quality: Characterizing Inpatient and Outpatient Palliative Care Populations. J Pain Symptom Manage. 2016 Jun;51(6):1033-1039.e3.
Journal cover image

Published In

J Pain Symptom Manage

DOI

EISSN

1873-6513

Publication Date

June 2016

Volume

51

Issue

6

Start / End Page

1033 / 1039.e3

Location

United States

Related Subject Headings

  • Young Adult
  • Registries
  • Quality of Life
  • Quality of Health Care
  • Palliative Care
  • Outpatients
  • Odds Ratio
  • Multivariate Analysis
  • Middle Aged
  • Male