The nursing home culture change movement aims to improve resident quality of life and quality of care by emphasizing the deinstitutionalization of nursing home culture and focusing on person-centered care.
Understanding how patients experience care can encourage delivery of high-quality services. It also helps payers, including the Centers for Medicare & Medicaid Services, ensure that they pay for effective and efficient care.
If a medical treatment worked only a fraction of the time and resulted in bad outcomes more often than not, practitioners would not make this treatment the default approach. Yet that is exactly what has happened when it comes to CPR for individuals 85 years and older who suffer cardiac arrest in a community setting.
Research based primarily on reports from an individual's surviving relatives often suggests that end-of-life care experiences are particularly poor. However, this examination of reports from patients found that those who died within a year of being surveyed reported slightly better experiences than other enrollees.
It's remarkable how often primary care doctors never get around to talking with their patients about an advance care plan before that fateful day arrives. So my colleagues and I end up having the conversation in an ER conference room or the patient's bedside at 2 o'clock in the morning, writes Art Kellermann.
Despite remarkable progress in medical science, the global death rate is still 100 percent. So the question is not whether we will live, or die. The question is where and how we'll die, and who will be with us when we do.
Data on the treatment choices of terminally ill patients used to estimate the value they associate with care revealed that patients place high valuations on metastatic cancer therapy – on average, twenty-three times higher than its cost.
Estimation of six-month prognosis is essential in hospice referral decisions, but accurate, evidence-based tools to assist in this task are lacking. PROMPT, a new prognostic model incorporating health-related quality of life, demonstrates promising performance and potential value for hospice referral decisions.
Communication is an ongoing challenge for clinicians working with people facing life-threatening illnesses and end of life. Family conferences offer patient-focused, family-oriented care that brings together patients, family members, and health care providers.
Longitudinal studies examining care for seriously ill patients are needed to understand patients' experience of illness, evaluate interventions, and improve quality of care. Unfortunately, such studies face substantial methodological challenges. This article describes such challenges and the strategies used to overcome them in a successfully implemented palliative care intervention trial for veterans.
High Medicare spending is not associated with better health outcomes at a regional level, but patients admitted to California hospitals from 1999 to 2008 had lower inpatient mortality in those hospitals that spent more on end of life care.
The authors estimated at pounds 1.8 billion the cost to the taxpayer of care for the 127,000 patients dying from cancer in 2006. The equivalent cost for the 30,000 people dying from organ failure was pounds 553 million. Resources of pounds 16 to pounds 171 million could be released for cancer.
In this September 2010 Congressional Briefing, Neil Wenger describes a yearlong study on improving end-of-life care that can help policymakers address payment systems and other issues pertaining to quality of care for critically ill patients.
This study assessed hospice use by men dying of prostate cancer and compared the use of high-intensity care between those who did or did not enroll in hospice. Those who enroll in hospice are less likely to receive high-intensity end-of-life care.
Patients admitted to a teaching hospital for an end-of-life illness generally receive high-quality medical care, but there is a need for better communication about family expectations and for timely efforts to keep patients comfortable.
None of us can choose to live forever. But we can, usually, choose how to make the most of our remaining weeks, months, or years. Helping patients choose how to live well at the end of life lies at the heart of advance-care planning, write Steven M. Asch, Karl Lorenz, and Diane Meier.