Access to Outpatient Palliative Care: Insights From Michigan

BackgroundOutpatient palliative care provides supportive care to community-dwelling patients with serious illness who are not eligible or ready for hospice. Little is known about the services these clinics offer and the populations they serve. We conducted a cross-sectional study of outpatient palliative care clinics in Michigan to describe their services and identify gaps in care.MethodsWe identified 19 palliative care programs in Michigan whom we surveyed by mail. Programs were asked to report all outpatient palliative care clinics, their locations, operating practices, volumes, staffing, and service areas. The survey was anchored on the year 2021. We used descriptive statistics to summarize subjects' responses and a Geographic Information System (GIS) to map clinic locations.ResultsPalliative care programs in Michigan reported a total of 33 outpatient clinics in predominantly urban and suburban regions. Clinics operated an average of 3 half-days per week with an average of 119 new patient visits per year (range 6-477). Most clinics (93%) were able to conduct visits via telehealth. Nineteen (59%) accepted non-cancer diagnoses and thirteen (41%) accepted children. Only 2 (5%) saw patients with chronic pain without serious illness. Twenty-six (81%) had physicians, fourteen (60%) had advanced practice providers, and eleven (55%) had social workers on staff.ConclusionThere is limited access to outpatient palliative care in Michigan, especially in rural communities. Many clinics do not accept non-cancer or pediatric patients. Additionally, many clinics lack the full interdisciplinary team that is required to provide robust palliative care.