“Serious and complex illness” in quality improvement and policy reform for end-of-life care
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Americans are living longer — a mark of success in public health and medical care — but more will live the last few years with progressive illness and disability. The dominant conception of care delivery separates “aggressive” or life-extending care from “palliative” or death-accepting care, with an assumed “transition” between them. The physiology and the experience of this population are mismatched in this model. Here, we propose a more useful category for public policy and clinical quality improvement: persons who will die as a result of “serious and complex illness.” Delivery system changes could ensure reliable, continuous, and competent care to this population.
- Institute of Medicine. Field, MJ & Cassel, CK, eds. Approaching Death: Improving Care at the End of Life. Washington, DC: National Academy Press; 1997.
- Patient’s Bill of Rights Act of 1998: A Health Insurance Bill of Rights (S.2529).
- Presidential Memorandum Regarding Federal Agency Compliance with the Patient’s Bill of Rights. February 20, 1998.
- Chrvala CA, Sharfstein S, eds. Definition of Serious and Complex Medical Conditions. Washington, DC: National Academy Press; 1999.
- Lynn J. Potentially ineffective care in intensive care [letter]. JAMA. 1998;279:652.
- Fox E, Landrum-McNiff K, Zhong Z, Dawson NV, Wu AW, Lynn J. Evaluation of prognostic criteria for determining hospice eligibility in patients with advanced lung, heart or liver disease. SUPPORT Investigators Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatment. JAMA. 1999;282:1638–45. CrossRef
- Hammes BJ, Rooney BL. Death and end-of-life planning in one Midwestern community. Arch Intern Med. 1998;158:383–90. CrossRef
- Lynn J, Harrell F, Cohn F, Wagner D, Connors AF Jr. Prognoses of seriously ill hospitalized patients on the days before death: implications for patient care and public policy. New Horiz. 1997;5:56–61.
- Rich MW. Heart failure disease management: a critical review. J Cardiac Fail. 1999;5:64–75. CrossRef
- Lynn J, Teno JM, Harrell FE. Accurate prognostications of death. Opportunities and challenges for clinicians. West J Med. 1995; 63:250–7.
- Memorandum to National Hospice Organization State and Provider Organizations by then-President Jay Mahoney. OIG Final Report: Hospice Patients in Nursing Homes. September 25, 1997.
- Lynn J. Measuring quality of care at the end-of-life: a statement of principles. J Am Geriatr Soc. 1997;45:526–7.
- Foundation for Accountability (FACCT). A Consumer Voice on Health Care Quality. Portland, Or: FACCT; 1996.
- Medicare Payment Advisory Commission. Report to the Congress: Selected Medicare Issues. Washington, DC; MedPAC: 1999.
- Iezzoni LI, Ayanian JZ, Bates DW, Burstin HR. Sounding Board: Paying more fairly for Medicare capitated care. N Engl J Med. 1998;339:1933–8. CrossRef
- Lubitz JD, Riley GF. Trends in Medicare payments in the last year of life. N Engl J Med. 1993;328:1092–6. CrossRef
- Lamers WM. Hospice: enhancing the quality of life. Oncology. 1990;4:121–6.
- Kane RL. PACE: a model of integrated acute and long-term care. Hosp Pract (Off Ed). 1997;32:23–4, 27, 30.
- Berwick D. Quality comes home. Ann Intern Med. 1996;125:839–43.
- Available at The National Institutes of Health Office of Extramural Research home page at: http://www.nih.gov/grants/guide/rfa-files/RFA-NR-99-004.html.
- Lynn J, Schuster JL. Improving Care for the End-of-Life: A Sourcebook for Health Care Managers and Clinicians. New York, NY; Oxford University Press; 2000.
- Medicare Payment Advisory Commission. Report to the Congress: Context for a Changing Medicare Program. Washington, DC; MedPAC: 1998.
- Available at The Robert Wood Johnson Foundation home page at: http://rwjf.org/main.html.
- Available at the Project on Death in America home page at: http://firstname.lastname@example.org.
- Available at the home page for the American Medical Association Education for Physicians about End-of-Life Care (EPEC) Project at: http://www.ama-assn.org/ethic/epec/index.htm.
- Lo B, Snyder L, Sox HC. Care at the End of Life: guiding practice where there are no easy answers. Ann Intern Med. 1999;130:772–3.
- Lynn J, Schall MW, Milne C, Nolan KM, Kabcenell A. Quality improvements in end-of-life care: insights from two collaboratives. Joint Comm J Qual Improv. 2000;26:254–67.
- Battin MP. Euthanasia: the way we do it, the way they do it. J Pain Symptom Manage. 1991;6:298–305. CrossRef
- “Serious and complex illness” in quality improvement and policy reform for end-of-life care
Journal of General Internal Medicine
Volume 16, Issue 5 , pp 315-319
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