In 1997, The Robert Wood Johnson Foundation launched a national program Promoting Excellence in End-of-Life Care with a mission of improving care and quality of life for dying Americans and their families. We soon realized that the metaphor of a jigsaw puzzle seemed apt in describing our efforts to expand access to services and improve quality of care in a wide range of settings and with diverse populations. No single approach would suffice--a variety of strategies, models of care, and stakeholders are necessary to successfully complete the picture. This monograph represents one aspect of our work and one piece of the puzzle of ensuring that the highest quality of care, including palliative care, is available to all seriously ill patients and their families.