Palliative Care as a Consultation Model

Palliative care addresses fundamental problems in the healthcare system (such as subspecialization, fragmentation, lack of training in care of the chronically and seriously ill, and absent communication and coordination among providers and settings) by aligning the care delivered to patients with the care they desire, treating physical and psychosocial distress, focusing on skilled communication with patients, families, providers, and settings, and thereby improving the quality of care to the most frail, vulnerable patients in the society [1]. Numerous studies have shown that seriously ill patients often do not receive the kind of care they want [2, 3]. Specifically, in the last 6 months of life, Medicare beneficiaries spend between 1.3 and 5.7 days in the intensive care unit (ICU) [4], while 10.5–22.5% of Medicare deaths were associated with an ICU admission [5], and approximately 20% of Americans who died during a hospitalization spent time in an ICU during their final admission [6]. Intense healthcare utilization is not specific to the ICU—a retrospective review of Medicare data showed that 75% of decedents visited an Emergency Department (ED) in the last 6 months of life; half visited the ED in the last month of life and 68% of those patients who were admitted subsequently died in the hospital [7].