• Catherine Rl Brown, Amy T Hsu, Claire Kendall, Denise Marshall, Jose Pereira, Michelle Prentice, Jill Rice, Hsien-Yeang Seow, Glenys A Smith, Irene Ying, and Peter Tanuseputro.
• 1 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
• Palliat Med. 2018 Sep 1; 32 (8): 1334-1343.

BackgroundTo enable coordinated palliative care delivery, all clinicians should have basic palliative care skill sets ('generalist palliative care'). Specialists should have skills for managing complex and difficult cases ('specialist palliative care') and co-exist to support generalists through consultation care and transfer of care. Little information exists about the actual mixes of generalist and specialist palliative care.AimTo describe the models of physician-based palliative care services delivered to patients in the last 12 months of life.DesignThis is a population-based retrospective cohort study using linked health care administrative data.Setting/ParticipantsPhysicians providing palliative care services to a decedent cohort in Ontario, Canada. The decedent cohort consisted of all adults (18+ years) who died in Ontario, Canada between April 2011 and March 2015 ( n = 361,951).ResultsWe describe four major models of palliative care services: (1) 53.0% of decedents received no physician-based palliative care, (2) 21.2% received only generalist palliative care, (3) 14.7% received consultation palliative care (i.e. care from both specialists and generalists), and (4) 11.1% received only specialist palliative care. Among physicians providing palliative care ( n = 11,006), 95.3% had a generalist palliative care focus and 4.7% a specialist focus; 74.2% were trained as family physicians.ConclusionWe examined how often a coordinated palliative care model is delivered to a large decedent cohort and identified that few actually received consultation care. The majority of care, in both the palliative care generalist and specialist models, was delivered by family physicians. Further research should evaluate how different models of care impact patient outcomes and costs.

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