What Does Palliative Care Delivery Look Like?: A Retrospective Claims-Based Analysis.

Context

Timely palliative care (PC) is a marker of high-quality care for patients with poor-prognosis cancer, yet real-world delivery falls short of guideline-concordant care. Clinician type is an underexplored factor.

Objectives

This study characterizes PC delivery by clinician type among decedents with poor-prognosis cancer at hospitals with PC programs.

Methods

Using Medicare claims linked to the National Palliative Care Registry, we identified PC encounters in the last six months of life among decedents with poor-prognosis cancer. Billing clinicians were classified into team-based physician, independent physician, team-based advanced practice provider (APP), and independent APP. We performed analyses of clinician type distribution, timing, and encounter frequency, and examined whether clinician type at first visit and encounter frequency varied by staffing capacity.

Results

We identified 33,677 poor-prognosis cancer decedents attributed to 276 hospitals; 72.8% had at least one PC encounter. The most common clinician type was team-based physician (37%). 69% of patients whose first encounter was with an independent physician had it within 30 days of death, compared to 48% of patients with an independent APP, but were more often limited to only one encounter (61% vs. 30%). After adjusting for staffing capacity, team-based physician first encounters were associated with higher odds of 3+ encounters (Odds Ratio [OR]=2.88, 95% Confidence Interval [CI]=2.70-3.08) vs. independent physician encounters. Team-based APP first encounters were associated with lower odds of 3+ encounters (OR=0.88, 95% CI=0.79-0.97).

Conclusion

These findings establish a foundation for examining whether clinician type at first encounter relates to patient and hospital outcomes.