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emergency department, end-of-life care, health care utilization, hospital admissions, palliative care, primary care



  1. Murphy, Alana DNP, ARNP
  2. Siebert, Kathryn DNP, ARNP, OCN
  3. Owens, Darrell PhD, DNP, ARNP
  4. Doorenbos, Ardith PhD, RN, FAAN


The lack of primary care providers who are skilled in delivering palliative care may be contributing to higher utilization of health care services for people at the end of life. The purpose of this study was to explore the impact of combined primary and palliative care on health care utilization by patients with a life-limiting illness. Patients received care from a consistent provider via a primary palliative care clinic founded and directed by a nurse practitioner at a public hospital. Chart reviews were conducted on a convenience sample of 146 patients cared for by a primary palliative care clinic between July 1, 2010, and June 30, 2011. Health care utilization after enrolling with the clinic was compared with utilization in the 12 months before the date of enrollment. Statistical analyses estimated a 28.6% reduction in emergency visits after enrollment (95% confidence interval, 0.9%-48.5%, P = .0437) and a 20.2% reduction in hospital admissions (95% confidence interval, -0.7% to 36.8%, P = .0576). These findings suggest that combined primary and palliative care can decrease utilization of health care services by individuals with life-limiting conditions.