• Nrupen A Bhavsar, Kate Bloom, Jonathan Nicolla, Callie Gable, Abby Goodman, Andrew Olson, Matthew Harker, Janet Bull, and Donald H Taylor.
• 1 Division of General Internal Medicine, Department of Medicine , Duke University School of Medicine, Durham, North Carolina.
• J Palliat Med. 2017 Oct 1; 20 (10): 112011261120-1126.

BackgroundUse of palliative care has increased substantially as the population ages and as evidence for its benefits grows. However, there is limited information regarding which care activities are necessary for delivering high-quality, interdisciplinary, community-based palliative care.ObjectivesThis study aims to identify and measure the discrete clinical and administrative activities completed by a multidisciplinary team in a hospice provider-led model for providing community-based palliative care.Study DesignA time and motion study was conducted at three care settings within a large hospice and palliative care network and a process map was drawn to describe the personnel and activities recorded.MethodsResearchers recorded activities performed by clinical and administrative staff. Activities were categorized into those related to patient care, administrative duties, care coordination, and other. A process map of palliative care delivery was created and descriptive statistics were used to calculate the proportion of time spent on discrete activities and within each activity category.ResultsOver 50 hours of activities were recorded during which the clinicians interacted with 25 patients and engaged in 20 distinct tasks. Physicians spent 94% of their time on tasks related to patient care and 1% on administrative tasks. Nurse practitioners and registered nurses spent 82% and 53% of their time on patient-related tasks and 2% and 37% on administrative tasks, respectively.ConclusionThe delivery of palliative care is interdisciplinary and involves numerous discrete tasks and activities. Understanding the components of a community-based palliative care model is the first step to designing incentives to encourage its spread.

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