Primary Palliative Care for Emergency Medicine (PRIM-ER)

Inclusion Criteria: * Patients must demonstrate one-year mortality of at least 30 percent (score \> 6) according to the Gagne Index, a validated instrument used to measure all cause one-year mortality in community-dwelling older adults, calculated based on their prior 12 months before the index ED visit of Medicare claims. Exclusion Criteria: * ED patients transferred from a nursing home on the index ED visit will be excluded since prediction of mortality and disposition of such patients differs from community-dwelling adults. * Patients currently receiving hospice at the time of the index ED visit will also be excluded since they have already received services.