Reforming Care for Persons Near the End of Life

The Promise of Quality Improvement

Published in: Annals of Internal Medicine, v. 137, no. 2, July 16, 2002, p. E-117-E-122

Posted on RAND.org on January 01, 2002

by Joanne Lynn, Kevin M. Nolan, Andrea Kabcenell, David Weissman, Casey Milne, Donald M. Berwick

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Most people in developed countries will live with a serious, eventually fatal, chronic condition for months or years before dying; yet, the delivery of health care services has only just recently begun adapting to this reality. Quality improvement methods have been effective in helping clinical services to make substantial changes quickly. Quality improvement requires stating an aim, measuring success, and testing possible improvements. The testing of changes requires a clinical team to Plan, Do, Study, and Act on new insights (the PDSA cycle). Repeated PDSA cycles generate deep understanding of complex systems and make sustainable improvements rapidly. This paper discusses a composite case study in a nursing home setting, which builds on experience with multisite collaborative efforts and introduces quality improvement methods in the context of end-of-life care.

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