1º, 2º, 3º Model of Palliative Care Delivery
Primary Palliative Care
Primary palliative care is provided by all health care professionals whether they are
office or institutionally based. It is part of the basic competency of individual practitioners
and an expected part of primary care service delivery models. It is available to any patient
where he or she receives care. The recent initiative of the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO) on pain is an example of a regulatory way to ensure that
pain control is part of the primary care of all patients in its accredited institutions.
An effort to ensure that advance directives are completed by residents in a nursing home
would be a similar effort in primary palliative care.
Training in primary palliative care is available to physicians and other members of the
interdisciplinary team through EPEC, EPERC and ELNEC.
Secondary Palliative Care
Secondary palliative care exceeds the ability of primary care providers.
These are specialist services that support primary palliative care providers.
They provide care for patients through specialized consultation teams. Hospice agencies,
hospice units, palliative care teams, palliative medicine specialists and palliative care
units are all examples of secondary palliative care.
Although there is some overlap, secondary specialist palliative care is different from pain
specialists. Although they may, at times, work collaboratively in the care of an individual
patient, their patterns of practice and target patient populations are distinct.
The American Board of Hospice and
Palliative Medicine certifies individual physicians who have the ability to serve as
palliative medicine specialists in their communities. Standards for specialist physician
training in palliative medicine are being developed. The Hospice and Palliative Nurses
Association certifies nurses in hospice and palliative care.
Tertiary Palliative Care
Tertiary palliative care exceeds the ability of secondary palliative care. It is provided
by referral centers with expertise in difficult problems. Tertiary palliative care
providers are also responsible for education and research. Fellowship programs have
developed to train physicians for specialist care.
CAPC Resources:
Additional resources on "Organizational Models for Palliative Care"
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CAPCManual Attribution:
von Gunten CF,
Ferris FD,
Portenoy RK,
Glajchen M, eds.
CAPCManual: How to Establish A Palliative Care Program.
New York, NY: Center to Advance Palliative Care, 2001.
©
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, CA
and
The Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, 2001
Permission to reproduce for non-commercial educational purposes with display of
attribution and
copyright is granted.
Last updated: February 20, 2002
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Elements
Select section:
Basis, Context, Components,
Case Examples
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Basis of Palliative Care Practice
Palliative Care Definitions
Historical Definitions
WHO
Oxford Textbook
ABHPM
NHPCO
Palliative Care
Applicability
Application to Patients at Risk
Differences–Hospice & Palliative Care
Values, Ethical Principles
Values
Ethical Principles
Conceptual Framework
Square of Care
Square of Organization
Square of Care & Organization
Norms / Standards of Practice
Guidelines
Policies, Procedures
What are They?
Developing, Implementing, Evaluating
Measures
Definitions of Common Terms
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Context
Tensions
In Therapeutic Relationships
Within Host Organizations
Within Healthcare System, Community
Who's the Customer
US Healthcare
Acute Care Hospitals
Long-term Care Facilities
Home
Hospice Care
Financing US Healthcare
Expenditures for EOL Care
Overview by Settings, Revenue Sources
Medicare
Medicaid
Commercial Insurers
Managed Care
Government (VA, Military)
Financing
Community Hospitals
Academic Hospitals
Subacute, Skilled Care
Custodial Care
Ambulatory Care
Home Care
Hospice Care
Eligibility
Covered Services
Reimbursement Rates
Unintended Consequences
Financing Physicians
Coding
Procedure / Service Codes
Coding Based on Time
Frequently Used E/M Codes
Example
Addition of Procedure Codes
Diagnosis Codes
ICD-9 Codes for Palliative Care
Avoiding Concurrent Billing Problems
Example
Documentation
Example
Physician Reimbursement
Medicare
Medicare Hospice Benefit
Non-hospice Physicians
Associated with a Hospice
Medicaid
Commercial Insurers
Managed Care
Government (VA, Military)
Financing Non-physician Providers
Hospital–Hospice Relationships
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Program Components
1º, 2º, 3º Model of Palliative Care Delivery
Interdisciplinary Care
Members of Interdisciplinary Team
Core Competencies
Physician
Nurse
Social Worker
Chaplain
Volunteer
Specialized Environments
Types of Services
Consultation Services
Consultation Etiquette
Consultation Documentation
Sample Note
Inpatient Units
Developing an Inpatient Unit
Staffing
Acuity
Nursing Model
Unit Size
General Ward vs. Palliative Care Unit
Roles
Decisions
Case Example
Nursing Staff
Physician Staff
Other Staff
Advice
Home Care
Eligibility, Medicare Home Health Benefit
Covered Services
Usually Not Covered
Hospice Care at Home
Ambulatory Outpatient Care
Respite Care
Financing Palliative Care Programs
Acute Hospital
Skilled Care Nursing Home
Hospice
Home Health
Ambulatory Outpatient
Managed Care
Financing Physicians in Palliative Care
Financing Non-physicians in Palliative Care
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Case Examples
CAPCManual Case Examples
Pioneer Program Case Examples
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