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An improvement team might establish a baseline for how it manages depression by reviewing medical records for the last 10 or 20 patients who died in the unit or hospice. Statistics suggest that several of these people will have been clinically depressed. In fact, did any patients have symptoms of depression? Were patients asked about their moods? Were any patients prescribed antidepressants?
A team could then set an aim that at least 80 percent of depressed patients would be treated. Begin to chart the rates at which antidepressants are prescribed, the number of patients referred to mental health professionals or support groups, and the number of patients who actually followed the referral.
Once an organization has a sense of its performance, setting aims becomes easy: for instance, that all end-of-life patients will be screened for depression and that all identified as being depressed are offered mental health counseling and/or antidepressant treatment, along with follow-up.
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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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