Improving Care for the End of Life, Online Edition The Palliative Care Policy Center

Sourcebook : Improving Care for the End of Life : 3.13 Develop Follow-up Procedures

Kaiser Permanente, San Diego

Hospice staff from the Kaiser Permanente-San Diego team identified several problems: At admission, more than half of the patients admitted to the hospice had significant, uncontrolled pain. There were no standard methods for pain assessment or for follow-up on pain management. To improve this situation, the team began to hold biweekly meetings, creating for the first time a sustained effort between hospice, continuing care, and oncology professionals.

The group focused on three aims for end-of-life patients visiting oncologists' offices:

The team changed what had become routine by:

Graphic comparison showing better pain control upon hospice assessment At the first follow-up phone call, most patients who had been in pain still reported problems - but nearly all could be managed over the phone by a nurse. By the end of the project:

The team was so successful that the project is now being expanded throughout the department and southern California Kaiser Permanente plans.


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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.

For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].

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