# Outpatient Palliative Care Implementation to Improve Outcomes for AgingVeterans

> **NIH VA IK2** · DURHAM VA MEDICAL CENTER · 2024 · —

## Abstract

Nearly one in three older veterans have multi-morbidity, many of whom manage life-limiting conditions
(LLC) and may benefit from palliative care (PC).1,2 A PC consultation is an opportunity to review care goals and
manage complex medical and psychosocial needs for veterans with LLCs. PC improves quality of life and
quality of end-of-life (EOL) care; however, most research has been conducted in the inpatient setting.3-7 In
2009, the VA Comprehensive End of Life Care Initiative established Palliative Care Consult Teams (PCCT)
with infrastructure investments largely in inpatient settings. In 2013, VA Geriatrics and Extended Care began
expanding outpatient PC (OPC) services. Despite increasing use of OPC in the VA, little is known about the
implementation and effectiveness of OPC in the VA. Preliminary evidence suggests OPC consults may be
effective in patients with certain LLCs; however, effects are heterogeneous across potentially eligible patients.
To improve appropriate PC use, critical gaps include lack of knowledge about OPC patterns (OPC consult
characteristics and timing relative to inpatient PC, hospitalization, death) and PCCT structural characteristics
and care practices. This project will generate the foundational knowledge needed to support an IIR proposal to
compare effectiveness of OPC models and evaluate under what conditions OPC improves Veteran outcomes.
 My CDA employs an explanatory sequential design starting with quantitative analyses of OPC reach and
patterns of use (aim 1) followed by enhanced interpretation using qualitative data (aim 2) and together these
findings will inform the development of a site-level survey measuring PCCT structural characteristics and OPC
practices (aim 3). Veteran engagement will include additional discussions with the local Veteran engagement
board, and an advisory board (with representatives from the Veteran Engagement Board), ensuring this research
is integrated with operational and veteran priorities. Aim 1.1 uses CDW data to Identify and describe common
OPC patterns among aging veterans with LLC. Aim 1.2 will evaluate veteran- and site-level predictors of OPC
patterns and identify sites with high and low OPC reach to inform Aim 2. Through interviews with PCCT members
and leadership (n=18-24), Aim 2 will characterize OPC patterns and perceived organizational determinants of
OPC reach, applying PRISM constructs from the Organizational Perspective domain. Themes will be compared
between 3 high and 3 low reach sites. Aim 3 will adapt and pilot a recent GEC survey for Home Based Primary
Care (HBPC) to collect data in 5 domains: structure/resources, leadership/team characteristics, referral
workflows, patient groups served, and care components. Finally, Aim 4 will evaluate health services use
associated with OPC consult and how outcomes differ across common OPC patterns.
 My CDA will culminate in the development and dissemination of a Palliative Care Pathways report that
describes common patterns, seq...

## Key facts

- **NIH application ID:** 10759368
- **Project number:** 5IK2HX003244-03
- **Recipient organization:** DURHAM VA MEDICAL CENTER
- **Principal Investigator:** Brystana G. Kaufman
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-01-01 → 2026-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10759368

## Citation

> US National Institutes of Health, RePORTER application 10759368, Outpatient Palliative Care Implementation to Improve Outcomes for AgingVeterans (5IK2HX003244-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10759368. Licensed CC0.

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