Bridging the Gap: Understanding Barriers in Transitions from Inpatient to Outpatient Palliative Care

Key Message : Transitions from inpatient to outpatient palliative care are frequently unsuccessful due to system-level and socioeconomic barriers. Identifying and addressing these gaps through standardized workflows and equity-focused interventions can improve continuity and access to longitudinal palliative care.

Abstract:

Background:
Many patients seen by inpatient palliative care teams do not successfully establish follow-up in outpatient palliative care clinics after hospital discharge. Missed transitions contribute to fragmented care, reduced symptom management, and poorer quality of life. Identifying barriers to outpatient palliative care engagement, particularly those rooted in system-based problems and socioeconomic disparities, is essential to improving continuity and equity in serious illness care.

Methods:
We plan to conduct a quality improvement project evaluating the percentage of patients seen by inpatient palliative care teams who established with outpatient palliative care within 30 days of hospital discharge over a 12-month period at University of North Carolina. Electronic health record review will be used to identify referral patterns, completion of outpatient appointments, and patient-level factors (insurance status, zip code, race/ethnicity, diagnosis, distance from clinic). Semi-structured interviews with inpatient and outpatient clinicians will explore perceived barriers and workflow gaps.

Results:
On initial data review, we anticipate that percentage of patients establishing with outpatient palliative care after discharge is below our institutional goals. We anticipate that common barriers include scheduling delays, transportation challenges, limited insurance coverage, and unclear handoff processes. We will also explore whether patients from lower-income zip codes and/or rural areas and those with public insurance are less likely to complete follow-up.

Conclusions:
This project plans to highlight key systemic and socioeconomic barriers limiting continuity between inpatient and outpatient palliative care. Ongoing interventions include development of a standardized referral workflow and enhanced communication between inpatient and outpatient teams. Future steps will evaluate whether these changes improve follow-up rates and reduce disparities in access to longitudinal palliative care.

References: No references.