Building a Supportive Oncology Practice that Impacts Emergency Department Visits, Hospice Utilization, and Hospital Admission.

INTRODUCTION: Palliative care remains underutilized despite evidence supporting its value. Multiple professional organizations have endorsed broader and earlier access to palliative care, yet barriers exist that impede successful implementation of palliative care. We report on development of an ambulatory palliative medicine practice (Supportive Oncology) embedded within an academic cancer center.

METHODS: An incremental strategy was used to ensure the sustainability of the practice. A needs assessment of oncologists gauged perceptions of unmet patient needs, attitudes toward palliative care, reasons for referrals, and vision of a relationship with palliative care. Clinical outcomes included practice volume, healthcare utilization, and hospice enrollment.

RESULTS: Key themes identified included diverse palliative care needs, variable reasons for referral, and lack of consensus on palliative care's role as a consultant or comanagement model. Supportive oncology visits were associated with a 12% reduction in emergency department visits and a 39% decrease in the cost of each visit. Percentage of hospice enrollment 30 days before death exceeded the national average, and was twice the local average.

CONCLUSION: Providing ambulatory palliative care simultaneously with disease-directed oncologic care improves healthcare value. Despite regional variations in hospital culture and patient populations, the model described here can be adapted in a variety of settings. More research is needed to identify the optimal model of ambulatory palliative care delivery, including type and structure of integration, needs of patients, and level of generalist-level palliative care provided by oncologists.