Hundreds of critically ill patients come to the University of Missouri Health Care system in a given year and receive palliative care within the hospital. Some of those patients are referred to hospice care. However, some are referred back to their local providers to receive community based palliative care. However, many of these local providers are unsure of what palliative care is and if they do understand what this involves, are unable to provide that without close contact with a physician who has focused knowledge of palliative care practices. Beginning in the summer of 2009, CHCQ, along with Dr. Clay Anderson, we begin analyzing University of Missouri Health Care data in an effort to first, understand this group of patients who are sent back to local physicians and second, to gather information concerning these providers’ knowledge of palliative care practices. A goal of this work will be to produce educational material that will help guide these providers in terms of offering palliative care for patients.