{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T04:26:08Z","timestamp":1777782368930,"version":"3.51.4"},"reference-count":36,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"United States (US) Department of Veterans Affairs, Health Services Research & Development Career Development Award","award":["CDA 20-032"],"award-info":[{"award-number":["CDA 20-032"]}]},{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation","award":["CIN 13-410"],"award-info":[{"award-number":["CIN 13-410"]}]},{"name":"U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Research Career Scientist Program","award":["RCS-21-137"],"award-info":[{"award-number":["RCS-21-137"]}]},{"name":"U.S. Department of Veterans Affairs, Health Services Research & Development Merit Award","award":["IIR 12-379"],"award-info":[{"award-number":["IIR 12-379"]}]},{"DOI":"10.13039\/100007181","name":"Quality Enhancement Research Initiative","doi-asserted-by":"publisher","award":["QUE-16-170"],"award-info":[{"award-number":["QUE-16-170"]}],"id":[{"id":"10.13039\/100007181","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Michigan HEAL","award":["K12NS130673"],"award-info":[{"award-number":["K12NS130673"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Appl Gerontol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>\n                    To develop strategies to better meet palliative needs for older adults, it is critical to understand what factors influence the implementation and sustainability of palliative care (PC) in the outpatient setting. This study explored provider perceptions about multi-level factors impacting implementation of outpatient PC. Applying an implementation science framework, barriers and facilitators were identified for key implementation and sustainability concepts within the provider, organizational context, and external levels. Provider perceptions were explored using semi-structured group interviews (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 11) with 9 outpatient specialty PC teams. Participants (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 26) included outpatient PC team members and team leaders. Key considerations for health systems seeking to implement or expand outpatient PC include addressing misperceptions, co-location with referring clinical teams, and building the PC workforce to support interdisciplinary PC teams. To address challenges communicating benefits of PC, improved performance measures are needed to document and incentivize appropriate referral and use of PC throughout the continuum of care.\n                  <\/jats:p>","DOI":"10.1177\/07334648251343484","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T15:46:21Z","timestamp":1748360781000},"page":"453-465","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Multi-Level Factors Impacting Implementation of Outpatient Palliative Care: Perceptions of VA Providers"],"prefix":"10.1177","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6553-0406","authenticated-orcid":false,"given":"Brystana G.","family":"Kaufman","sequence":"first","affiliation":[{"name":"Durham VA Health Care System"},{"name":"Duke University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiera J.","family":"Lanford","sequence":"additional","affiliation":[{"name":"Durham VA Health Care System"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina R.","family":"Sperber","sequence":"additional","affiliation":[{"name":"Durham VA Health Care System"},{"name":"Duke University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9607-0005","authenticated-orcid":false,"given":"Catherine","family":"Stanwyck","sequence":"additional","affiliation":[{"name":"Durham VA Health Care System"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica E.","family":"Ma","sequence":"additional","affiliation":[{"name":"Durham VA Health Care System"},{"name":"Duke University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua M.","family":"Thorpe","sequence":"additional","affiliation":[{"name":"VA Pittsburgh Healthcare System"},{"name":"University of North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. 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