Quality Improvements in End of Life Care: Insights from Two Collaboratives

Lynn, Joanne; Schall, Marie W.; Milne, Casey; Nolan, Kevin; Kabcenell, Andrea

doi:10.1016/s1070-3241(00)26020-3

Cited by 56 publications

(44 citation statements)

References 18 publications

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“…[46][47][48][49] These quality improvement results are being confirmed by more rigorous external evaluations. [50][51][52][53][54] In the largest and most comprehensive evaluation of CCM-based improvement programs, investigators from the RAND Corporation found significantly better patient satisfaction with communication among heart failure and asthma patients in practices involved in system change.…”

Section: Clinical Information Systemsmentioning

confidence: 75%

Finding Common Ground: Patient-Centeredness and Evidence-Based Chronic Illness Care

Wagner

Bennett

Austin

et al. 2005

The Journal of Alternative and Complementary Medicine

354

356

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Health outcomes for patients with major chronic illnesses depend on the appropriate use of proven pharmaceuticals and other therapeutic technologies, and effective self-management by patients. Effective chronic illness care then bases clinical decisions on the best, rigorous scientific evidence, or evidence-based medicine. Effective support for patient self-management includes efforts to increase patient participation in care and collaborative goal-setting and planning of treatment. These interventions appear somewhat consistent with recent conceptualizations of patient-centered care. The consistent delivery of proven therapies and information and support for self-management requires practice systems organized for that purpose. The Chronic Care Model is a compilation of those practice system changes shown to improve chronic care. This paper explores the concept of patient-centeredness and its relationship to the Chronic Care Model. We conclude that the Model is both evidence-based and patient-centered and that these can be properties of health systems, and not just of individual practitioners.

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Section: Clinical Information Systemsmentioning

confidence: 75%

Finding Common Ground: Patient-Centeredness and Evidence-Based Chronic Illness Care

Wagner

Bennett

Austin

et al. 2005

The Journal of Alternative and Complementary Medicine

354

356

View full text Add to dashboard Cite

show abstract

“…48,49 Elements that contribute to successful organizational change include strong leadership support and sponsorship, development of a consistent organizational model, networking and information sharing among providers, engagement of the staff to collaborate in teamwork to test initiatives, and availability of performance data that feed back to organizational leaders to sustain changes. 50,51 Inadequate hospital policies on DNR discussion standards.…”

Section: Reasons For Inadequate Dnr Discussion and Recommended Stratmentioning

confidence: 99%

Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them

2011

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Do-not-resuscitate (DNR) orders have been in use in hospitals nationwide for over 20 years. Nonetheless, as currently implemented, they fail to adequately fulfill their two intended purposes-to support patient autonomy and to prevent non-beneficial interventions. These failures lead to serious consequences. Patients are deprived of the opportunity to make informed decisions regarding resuscitation, and CPR is performed on patients who would have wanted it withheld or are harmed by the procedure. This article highlights the persistent problems with today's use of inpatient DNR orders, i.e., DNR discussions do not occur frequently enough and occur too late in the course of patients' illnesses to allow their participation in resuscitation decisions. Furthermore, many physicians fail to provide adequate information to allow patients or surrogates to make informed decisions and inappropriately extrapolate DNR orders to limit other treatments. Because these failings are primarily due to systemic factors that result in deficient physician behaviors, we propose strategies to target these factors including changing the hospital culture, reforming hospital policies on DNR discussions, mandating provider communication skills training, and using financial incentives. These strategies could help overcome existing barriers to proper DNR discussions and align the use of DNR orders closer to their intended purposes of supporting patient selfdetermination and avoiding non-beneficial interventions at the end of life.KEY WORDS: do-not-resuscitate orders; informed consent; end-of-life care.

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“…For example, our work with 35 teams on improved care for persons with advanced heart or lung failure taught us specific insights about advance care planning and dyspnea relief, as well as about how to move conventional care systems toward optimal services. 21 Settling how one responsibly assesses the validity and reliability of insights arising from quality improvement is central to the debate about ethics. If the findings of quality improvement projects are largely worthwhile in shaping the care system, one would certainly not want to make it difficult to measure the changing system performance in order to guide changes.…”

Section: Box 1 Institutional Review Boardsmentioning

confidence: 99%

When does quality improvement count as research? Human subject protection and theories of knowledge

Lynn¹

2004

Quality and Safety in Health Care

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Quality Improvements in End of Life Care: Insights from Two Collaboratives

Cited by 56 publications

References 18 publications

Finding Common Ground: Patient-Centeredness and Evidence-Based Chronic Illness Care

Finding Common Ground: Patient-Centeredness and Evidence-Based Chronic Illness Care

Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them

When does quality improvement count as research? Human subject protection and theories of knowledge

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