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Original Investigation
Health Care Reform
April 11, 2011

The Optimal Delivery of Palliative Care: A National Comparison of the Outcomes of Consultation Teams vs Inpatient Units

Author Affiliations

Author Affiliations: Division of Geriatric Medicine, School of Medicine, University of Pennsylvania (Dr Casarett), and Center for Health Equity Research and Promotion, Department of Veterans Affairs Medical Center (Mss Johnson and Smith and Dr Richardson), Philadelphia.

Arch Intern Med. 2011;171(7):649-655. doi:10.1001/archinternmed.2011.87

Background  Growing attention to end-of-life care has led to intensive efforts to provide better palliative care. However, it is not known whether palliative care is best provided by consultative teams or in dedicated units.

Methods  This nationwide telephone survey was conducted in 77 Veterans Affairs medical centers that offer palliative care consultation services and dedicated palliative care units. One family member per patient who died at a participating Veterans Affairs medical center between July 1, 2008, and December 31, 2009, was invited to participate. The telephone survey included 1 global rating item and 9 core items describing the patient's care in the last month of life.

Results  Interviews were completed with family members for 5901 of 9546 patients. Of these, 1873 received usual care, 1549 received a palliative care consultation, and 2479 received care in a palliative care unit. After nonresponse weighting and propensity score adjustment, families of patients who received a palliative care consultation were more likely than those who received usual care to report that the patient's care in the last month of life had been “excellent” (adjusted proportions: 51% vs 46%; odds ratio [OR], 1.25; 95% confidence interval [CI], 1.02-1.55; P = .04). However, families of patients who received care in a palliative care unit were even more likely to report excellent care (adjusted proportions: 63% vs 53%; OR, 1.52; 95% CI, 1.25-1.85; P < .001).

Conclusion  Care received in palliative care units may offer more improvements in care than those achieved with palliative care consultations.