Who Gets Early Palliative Care? Predictors of Timely Inpatient Consultation within the Southeast

Key Message : In a large Southeastern health system, timely palliative care (≤72 hours) was influenced by diagnosis, age, socioeconomic context, and admission factors. Cancer predicted earlier consults, while ESRD and heart failure lagged. Higher social disadvantage was associated with delays. EHR-triggered pathways and targeted education can reduce inequities and standardize timely access.

Abstract: Background/Rationale:
Early inpatient palliative care consultation (PCC) improves symptoms, transitions, and resource use, yet timing is inconsistent. Identifying who receives timely PCC can standardize referrals and improve equity.
Objectives/

Purpose:
To identify clinical and demographic predictors of timely PCC within a large, multi-hospital Southeastern U.S. health system.
Methods/Approach:
We conducted a retrospective cohort study of adults hospitalized with a primary or secondary diagnosis of cancer, dementia, ESRD, or heart failure who received inpatient PCC between April 2024 and March 2025. The outcome was consultation timing: timely (≤72 hours from admission) versus late (>72 hours). Predictors included age, sex, race/ethnicity, payer, diagnosis group (cancer, dementia, ESRD, heart failure, multimorbidity), Area Deprivation Index (ADI), admission type, and hospital site. Multivariable logistic regression was performed using two models: Model 1 (demographics only) and Model 2 (including clinical and contextual variables).

Results:
Among 13,450 eligible patients, 55% received timely PCC. Approximately 30% were hospitalized due to heart failure or cancer, 13% due to dementia, 2% due to ESRD, and 27% due to multiple conditions. In Model 1, older age (80+ vs 18–64) and female sex were associated with higher odds of timely consultation, while Medicare coverage and residence in the most socially deprived areas predicted lower odds. In Model 2, patients with cancer were more likely to receive timely PCC, while those with ESRD were less likely than heart failure patients. Emergent admission increased odds of timely PCC. Older age and female sex remained protective. The ADI association reversed—patients in the most disadvantaged areas were more likely to receive timely PCC.
Conclusion/Implications:
Access to timely palliative care is not universal. The ADI shift likely reflects complex socioeconomic and clinical factors. Delays among non-cancer and socially deprived patients highlight systemic inequities. Standardized EHR-based triggers and targeted education could ensure more consistent, equitable inpatient palliative care delivery.

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2. Casarett, D., Pickard, A., Bailey, F. A., et al. (2008). Do palliative consultations improve patient outcomes? Journal of the American Geriatrics Society, 56(4), 593–599.
3. Wachterman, M. W., Pilver, C., Smith, D., et al. (2016). Quality of end-of-life care provided to patients with different serious illnesses. JAMA, 316(11), 1167–1175