ABCD Exchange : April 1999 : QuickScan - News in Brief

Upfront - Angola Prison Hospice
President's Letter - When the Care System Fails
Lunch Bunch - New Models of Grief
In the States - Sanctions for Undertreating Pain

News and Notes on End-of-Life Issues

Washington, DC - The Health Care Financing Administration (HCFA) recently began a program to assess best practices in coordinated care for chronic illness and to design demonstration projects. The demonstrationís purpose is to evaluate models of care provided to specific Medicare beneficiaries, and to reduce Medicare expenditures. Mathematica Policy Research, Inc., study coordinator, is seeking nominations via a website at www.mathematica-mpr.com/projects/bestpractices/. The online survey requires detailed information, which must be submitted by June 21. Paper copies (one original and three copies) can be sent to Ms. Kristin LaBounty, Mathematica Policy Research, Inc., PO Box 2393, Princeton, NJ 08543-2393.

Glenview, IL - A survey of 805 people reports that more than four out of ten with moderate to severe pain have yet to find adequate relief and that their pain is out of control. The American Pain Society, the American Academy of Pain Medicine, and Janssen Pharmaceutica report that many patients do not receive the type of care experts deem necessary—although nearly half of those surveyed have switched doctors at least once and more than half have been in pain for more than five years. Survey respondents who had been treated with opioids said that this treatment was most effective, yet only about a quarter of respondents with very severe pain reported taking opioids. According to Russell Portenoy, M.D., "This survey shows the stigma associated with opioid drugs. Although these drugs can clearly benefit some patients with chronic pain, patients, caregivers and physicians overestimate the risks and fail to use them appropriately," Portenoy said. For more information, visit the American Pain Society web site at www.ampainsoc.org/whatsnew.

On the Web - Two new interesting sites to advocates for better end-of-life care are "Nursing Home Compare," at the Medicare.gov site, and the National Guideline Clearinghouse at guidelines.gov, which features evidence-based clinical practice guidelines. The Nursing Home site allows the public to compare survey results and safety violations at 17,000 certified nursing homes. In May, the Health Care Financing Administration will launch a public education campaign to inform residents, families and the public about nursing home issues, including patient rights. At the guidelines site, users can review standardized abstracts and tables to compare guidelines on similar topics. Developed by the Agency for Health Care Policy and Research with the American Medical Association and the American Medical Association, the site also includes discussion groups for exchange about guideline development, content and use.

Board of Directors
Ellen Fox, MD, Secretary
Adjunct Associate Professor
The George Washington University
Joanne Lynn, MD, President
Professor, Department of
Healthcare Sciences
The George Washington University
Anna Moretti, RN
Education Coordinator,
Montgomery Hospice Society
Isabel Murray, RN, retired
Volunteer, Hospice of Washington
John H. Pickering, Esq.
Wilmer, Cutler & Pickering
Chair, Senior Bar, American Bar Assn
Charles Sabatino, Esq., Vice President
Assistant Director,
American Bar Association
Commission on Legal Problems
of the Elderly
Michael Werner, JD, Treasurer
Counsel for Policy and Legislative Affairs
American College of Physicians-ASIM
Anne Boling, Executive Director
Americans for Better Care of the Dying

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