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

Sourcebook : Improving Care for the End of Life : Part III Arrangements to Promote Reform

While rapid-cycle changes described in previous chapters offer a model for improving patient care, organizations can promote systemwide change through administrative improvements and reform. The chapters in this section describe current arrangements or practices in four specific areas and then look at ways to improve or change those practices for everyone's benefit, not only patients and families but staff as well.

Chapter 8 describes models for hospital-based palliative care units and consultations, which extend hospice principles to patients who are ineligible for hospice, either because of their prognosis or because they desire to continue aggressive treatment although they realize that their diseases are eventually fatal. (For instance, new treatment regimes allow HIV/AIDS patients to live much longer, but issues of advance care planning and palliation of symptoms are still critical to these patients and their loved ones.)

Chapter 9 discusses how Medicare now reimburses end-of-life medical expenses and suggests what managers need to consider in structuring and financing any new program to care for patients at the end of life. The chapter describes how programs can bill Medicare appropriately and discusses the likely income that such billing will generate.

Chapter 10 offers ideas on how groups can use their management information systems - whether they are very basic or cutting-edge technology - to measure quality improvement endeavors.

Chapter 11 looks at some of the issues and concerns surrounding personnel who work in end-of-life care, such as offering bereavement counseling to staff and creating career paths for paraprofessional workers.

Previous chapters included many examples of how groups have applied quality improvement methods to create change. The following chapters describe the exemplary efforts some groups are trying: Although their progress and accomplishments have not all been rigorously tested or measured, their ideas seem to be good ones, and worth consideration by others.

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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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