Models of Care Delivery and Quality Measurement
Two main models of care delivery have emerged for palliative care delivery to surgical patients: the consultative model, which relies on triggers for palliative care consultations, and the integrative model, which delivers palliative care alongside standard treatments. While both these models have shown success among nonsurgical populations, only a few studies have examined their utilization among surgical patients. Even though these models provide palliative care delivery to patients, indicators of quality are also necessary to ensure that palliative delivery improves quality of care. However, the most relevant and important indicators of quality for surgical palliative care remain undefined. Presently, there is no national surgical quality improvement program for palliative care, hindering attempts to measure quality and improve performance. However, the surgical specialties can adapt and learn from related specialties, such as critical care, geriatrics, oncology, and palliative and hospice medicine, to develop quality indicators for surgical palliative care. Capitalizing on existing quality structures, such as the American College of Surgeons quality improvement programs, can also help ensure integration of quality improvement efforts into standard practice.