TABLE 4.
Models of PC: Strength and Weaknesses
| Model | Description | Strengths | Weaknesses |
|---|---|---|---|
| 1. Outpatient PC clinics (freestanding) | PC providers (M.D.,N.P.,R.N.) conduct standalone PC clinics | 1. Continuity of care is easily established. 2. Centralized services. 3. Allows for more day-to-day planning and resource allocation. 4. Autonomy around concise and consistent referral criteria. 5. Hub for education and research In PC. |
1. Startup costs, overhead, and budgetary Implications to be considered to launch these clinics. 2. Need for additional support staff In the clinic. 3. Scheduling challenges may be unforeseen because of the high volume of patients but limited providers in these PC clinics. |
| 2. Embedded PC clinics | PC providers co-located within specialty care (e.g., oncology care model) | 1. Immediate access to PC within routine care. 2. Facilitates collaboration between PC and specialty providers. 3. Facilitates destigmatization of PC referral among providers and patients. 4. Cost effective for initial integration of PC within hepatology because of shared space, support staff, and other clinical resources. |
1. Consultation may be hastened because of space and volume issues, as the needs of Individual patients usually drive the PC consultation. 2. Patients may be rushed because of perception of spending too much time In the clinic and may not be prepared to spend additional time. 3. Financing may require more administrative support. |
| 3. Inpatient PC consultation | PC team consulted during hospitalization | 1. Identifies high-need population. 2. Helps reduce health care use and develop end-of-llfe care goals. |
1. Limited continuity of care. 2. Usually, It is too late for the patients to receive the plethora of benefits of PC. 3. Limited number of PC providers available for high needs of inpatients. |
| 4. Dedicated Inpatient PC units | PC team housed on one unit dedicated to deliver PC In conjunction with curative/ ongoing care | 1. A dedicated inpatient unit can help bring together resources needed to deliver the best PC. 2. Cost savings for the institution, as this can help reduce readmissions and health care use. |
1. Planning and Investment to design such a unit by the hospital administrators requires PC administrative expertise. 2. Ongoing challenges to maintain throughput, given the unit will care for a seriously ill population. |
| 5. Telehealth-based PC | Use of remote technology to deliver PC | 1. PC providers can deliver care to patients irrespective of the distance or patients’willingness to return to clinics for additional appointments. 2. Video conferencing provides a glimpse Into the homes and social contexts of patients, making PC more informed. |
1. Reimbursement is challenging and varies across states. 2. Relies on technology and is limited to those with access to the Internet. |
| 6. Home-based PC | PC providers conduct home visits and deliver PC at patient’s home | 1. Comfort at home Is maintained while PC continues. 2. Increased satisfaction with care. 3. Reduced hospitalizations and ED visits. 4. More at-home deaths. |
Limited availability and coverage. |
Abbreviations: ED, emergency department; M.D., medical doctor; N.P., nurse practitioner; PC, palliative care; R.N., registered nurse.