"Serious and Complex Illness" in Quality Improvement and Policy Reform for End-of-Life Care

by Joanne Lynn, Janet Heald Forlini

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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.

Reprinted with permission from Journal of General Internal Medicine, Vol. 16, No. 5, May 2001, pp. 315-319. Copyright © 2001 Society of General Internal Medicine.

Originally published in: Journal of General Internal Medicine, Vol. 16, No. 5, May 2001, pp. 315-319. Copyright © 2001 Society of General Internal Medicine.

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