A scoping review of the tiered model of palliative care delivery
Abstract
With the acceleration of population aging and the growing burden of chronic diseases, the demand for continuous and tiered palliative care services among patients at the end of life has increased substantially. The hospital-community-home three-tier linkage model provides an important pathway for palliative care resource allocation and service integration. This review focuses on the functional positioning, admission and discharge criteria, and bidirectional referral mechanisms within tiered palliative care, and summarizes current research progress and practical developments in this field. Existing evidence suggests that tiered palliative care should be guided by the principle of aligning patient care needs and complexity with institutional service capacity. Within this framework, hospitals primarily undertake the management of complex symptoms and the provision of technical support, community-based services emphasize continuous care for patients in relatively stable condition, and home-based care highlights patient preference, family support, and controllable symptom risk. Recent progress has mainly been reflected in the clearer definition of functional roles across different levels of care, the multidimensional refinement of admission and discharge criteria, and the gradual improvement of referral indications and transitional care processes. In admission assessment, increasing emphasis has been placed on the comprehensive evaluation of prognosis, functional status, symptom burden, caregiving resources and patient preferences. In referral coordination, greater attention has been directed toward dynamic management based on standardized assessment. However, several challenges remain in current practice, including non-uniform assessment indicators, unclear referral thresholds, insufficient cross-level information continuity, and limited service capacity in primary care settings. Overall, tiered palliative care in China has established a preliminary framework; however, further efforts are needed to improve its standardization, homogenization and operational feasibility.
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BibTeX
@article{shuting2026scoping,
title = {{A scoping review of the tiered model of palliative care delivery}},
author = {LI Shuting and CHENG Wenwu and JIANG Yan and ZHANG Jing},
journal = {Zhongguo aizheng zazhi},
year = {2026},
month = sep,
url = {http://www.china-oncology.com/zh/article/doi/10.19401/j.cnki.1007-3639.2026.09.008/},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - A scoping review of the tiered model of palliative care delivery
AU - LI Shuting
AU - CHENG Wenwu
AU - JIANG Yan
AU - ZHANG Jing
PY - 2026
DA - 2026/09/01
JO - Zhongguo aizheng zazhi
UR - http://www.china-oncology.com/zh/article/doi/10.19401/j.cnki.1007-3639.2026.09.008/
AB - With the acceleration of population aging and the growing burden of chronic diseases, the demand for continuous and tiered palliative care services among patients at the end of life has increased substantially. The hospital-community-home three-tier linkage model provides an important pathway for palliative care resource allocation and service integration. This review focuses on the functional positioning, admission and discharge criteria, and bidirectional referral mechanisms within tiered palliative care, and summarizes current research progress and practical developments in this field. Existing evidence suggests that tiered palliative care should be guided by the principle of aligning patient care needs and complexity with institutional service capacity. Within this framework, hospitals primarily undertake the management of complex symptoms and the provision of technical support, community-based services emphasize continuous care for patients in relatively stable condition, and home-based care highlights patient preference, family support, and controllable symptom risk. Recent progress has mainly been reflected in the clearer definition of functional roles across different levels of care, the multidimensional refinement of admission and discharge criteria, and the gradual improvement of referral indications and transitional care processes. In admission assessment, increasing emphasis has been placed on the comprehensive evaluation of prognosis, functional status, symptom burden, caregiving resources and patient preferences. In referral coordination, greater attention has been directed toward dynamic management based on standardized assessment. However, several challenges remain in current practice, including non-uniform assessment indicators, unclear referral thresholds, insufficient cross-level information continuity, and limited service capacity in primary care settings. Overall, tiered palliative care in China has established a preliminary framework; however, further efforts are needed to improve its standardization, homogenization and operational feasibility.
SN - 1007-3639
ER -