The Development and Clinical Impact of an Innovative Palliative Care Lever Tool for Individuals With Idiopathic Pulmonary Fibrosis: A Quality Improvement Project.

The project was done in a single outpatient department at an academic medical center, so it may not apply to other clinics. The implementation period was short, which may have missed later referrals after repeat screening. The sample was small, so it is limited as evidence that the tool changes palliative care use. Patients were identified using billing codes, so incorrect or outdated coding could have missed eligible patients. Patients seen by an attending physician without a nurse practitioner may not have been screened. Referrals and encounters outside the institution were not captured. Clinician education about palliative care happened at the same time, so its effect on referrals could not be separated. The referral outcome was not statistically significant, so the tool is not proven to increase palliative care use.

Do not read the increase in palliative care referrals or encounters as proof that the lever tool improves palliative care access. Both increases were not statistically significant, and the project was a short, single-site pilot.