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Measuring How Palliative Care is Delivered: Using Provider Sequences as a New Quality Signal
John J Shin1, Amber E Barnato2, Gabriel A Brooks3
1The Dartmouth Institute for Health Policy and Clinical Practice (J.J.S., A.E.B, G.A.B., A.M.C, A.J.O'M, I.S.K.), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
Journal of Pain and Symptom Management
|June 10, 2026
Summary
Understanding palliative care (PC) provider sequences in hospitals can improve end-of-life (EOL) outcomes. Specific sequences, like Independent Specialist to Team Specialist, correlate with increased hospice use.
Area of Science:
- Palliative Care Research
- Health Services Research
- Oncology Outcomes
Background:
- The impact of palliative care (PC) program composition and staffing on end-of-life (EOL) outcomes is not well understood.
- There is a need to analyze how PC services are delivered within hospital settings.
Purpose of the Study:
- To investigate longitudinal PC service delivery patterns using a data-driven approach.
- To explore the association between distinct PC provider sequences and EOL quality measures in advanced cancer patients.
Main Methods:
- Retrospective cohort study using 2018-2019 Medicare fee-for-service claims.
- Defined provider sequences based on consecutive PC encounters (Team Specialist, Independent Specialist, Primary).
- Quantified provider sequence patterns within hospitals and tested associations with EOL quality measures (ED visits, hospice use, hospice enrollment duration).
Main Results:
- A higher proportion of Independent Specialist→Team Specialist (IS→TS) sequences was linked to increased hospice use (beta=0.48).
- The Team Specialist→Primary (TS→P) sequence showed a negative association with hospice enrollment of 3 days or more (beta=-0.18).
Conclusions:
- Palliative care provider sequences may serve as a quality indicator within hospitals.
- Analyzing these sequences can offer insights into variations in EOL care quality and outcomes.
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