Table 3A.

Profile of a Hospital-Based Clinic

Name (contact)	Harborview Medical Center, Seattle, WA (Dr. Darryl Owens)
Patient volume	400 patients per year, including 100 new
Patient characteristics	50% with cancer, most common noncancer diagnoses are end-stage renal disease, end-stage liver disease, and dementia. Major reasons for referral are symptom management and goals-of-care discussions. 50% of referrals are from inpatient palliative care consultation services, 30% from oncologists, and 20% from nephrologists.
Practice characteristics	9 half-days of clinic/week with average of two exam rooms available per clinic session. New patient visits are 60 minutes, follow-up visits 30 minutes. Wait time averages 10 days.
Staffing	4 part-time physicians (fellows), 2 near full-time advanced practice nurses or nurse practitioners, 1 half-time social worker, 1 full-time nurse (RN)
Funding	50% billing, 40% institutional support, 10% foundation grant
Routinely collected data	Appointment data (e.g., no-shows, cancellations), demographics, hospital admissions, emergency department visits, hospice use, patient satisfaction, and date of death
Impetus for starting	“To provide continuity of care and 24-hour access to palliative care providers. The Primary Palliative Care Clinic was started to provide both primary and palliative care (with providers specialized in both) to patients with a life-limiting illness and no primary care provider. We are an inner city hospital where the wait list for establish primary care providers is over 400 patients long. We were asked by the nephrologists to provide primary care and pain management to their patients after I presented data from Woody Moss's presentation regarding end-stage kidney disease.”
Innovation	Strong public service mission: “We assume responsibility for management of patients released from prison on compassionate release for terminal illness. Approximately 20% of our patients are homeless. A majority have limited or no health insurance.”
Definition of success	“Avoidance of emergency department usage and readmission to the hospital.”
Challenges faced	Funding for staffing: “Our institution loves the concept and work of our clinic as long as they don't have to pay for much.”