TY - JOUR
T1 - Growth of an academic palliative medicine program
T2 - Patient encounters and clinical burden
AU - Dev, Rony
AU - Fabbro, Egidio Del
AU - Miles, Mikilisha
AU - Vala, Amy
AU - Hui, David
AU - Bruera, Eduardo
N1 - Funding Information:
Eduardo Bruera is supported in part by National Institutes of Health grants RO1NR010162-01A1 , RO1CA1222292.01 , and RO1CA124481-01 . Egidio Del Fabbro is supported in part by an American Cancer Society grant PEP-08-299-01-PC1 . The authors declare no conflicts of interest.
PY - 2013/2
Y1 - 2013/2
N2 - Context: Information regarding the challenges of clinical growth and staffing of palliative care programs is limited. Objectives: Our aim was to describe the growth and staffing structure of a palliative care program at a comprehensive cancer center. Methods: During fiscal years ending in 2000 through 2010, we recorded all billed palliative care consultations and follow-ups. To determine the yearly clinical burden per physician, advanced practice nurse (APN), and physician assistant (PA), we calculated the mean number of patient encounters per clinical full-time equivalents. Increase in absolute number of patient encounters and relative (%) growth from year to year were calculated. Results: Over the 10-year history of the program, the number of outpatient consultations tripled, whereas the inpatient consultations increased from 73 to 1880. In all cases, with the exception of the first year of operation, the vast majority of clinical activity was in the inpatient hospital setting. Growth in the ratio of inpatient consultations per operational hospital beds was noted during the first five years of the program followed by a more modest increase in the succeeding five years. In fiscal year 2010, palliative care physicians had 6.2 patient encounters per working day, and APNs/PAs independently evaluated and treated 4.0 additional patients. Conclusion: Over the 10-year history, there has been an increase in the number of patient consultations seen by our palliative care program. The clinical burden was manageable during the first three years but quickly became too burdensome. Active recruitment of new faculty was required to sustain the increased clinical activity.
AB - Context: Information regarding the challenges of clinical growth and staffing of palliative care programs is limited. Objectives: Our aim was to describe the growth and staffing structure of a palliative care program at a comprehensive cancer center. Methods: During fiscal years ending in 2000 through 2010, we recorded all billed palliative care consultations and follow-ups. To determine the yearly clinical burden per physician, advanced practice nurse (APN), and physician assistant (PA), we calculated the mean number of patient encounters per clinical full-time equivalents. Increase in absolute number of patient encounters and relative (%) growth from year to year were calculated. Results: Over the 10-year history of the program, the number of outpatient consultations tripled, whereas the inpatient consultations increased from 73 to 1880. In all cases, with the exception of the first year of operation, the vast majority of clinical activity was in the inpatient hospital setting. Growth in the ratio of inpatient consultations per operational hospital beds was noted during the first five years of the program followed by a more modest increase in the succeeding five years. In fiscal year 2010, palliative care physicians had 6.2 patient encounters per working day, and APNs/PAs independently evaluated and treated 4.0 additional patients. Conclusion: Over the 10-year history, there has been an increase in the number of patient consultations seen by our palliative care program. The clinical burden was manageable during the first three years but quickly became too burdensome. Active recruitment of new faculty was required to sustain the increased clinical activity.
KW - Palliative care
KW - program development
KW - supportive care
KW - workforce staffing
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U2 - 10.1016/j.jpainsymman.2012.02.015
DO - 10.1016/j.jpainsymman.2012.02.015
M3 - Article
C2 - 22889857
AN - SCOPUS:84873414632
SN - 0885-3924
VL - 45
SP - 261
EP - 271
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
IS - 2
ER -