CPCS : Quality Improvement Services : Why Improve Quality?

America urgently needs innovative solutions to the challenges involved with providing high quality, compassionate care to the chronically ill and dying. People with heart disease, emphysema, stroke, dementia, and many cancers often live for several months to several years, experiencing intervening episodes of serious complications before dying at an unpredictable time. The numbers of people who are very sick at the same time will continue to rise for the next three decades, as baby boomers grow older, doubling from present rates by 2030 due to medical advances and demographic trends.

Some brief facts about the current environment at both the patient and the wider health care system levels illustrate the severity of the problem:

The Patient Environment

• Serious chronic illness is now concentrated in old age. Seventy-five percent of Americans die past age 65 while covered by Medicare.
• Americans are likely to live for months or years with the diseases that eventually cause death.
• Many Americans are disabled for many months or years by diseases such as heart disease, emphysema, stroke, dementia, and even cancers like breast cancer and prostate cancer, experiencing intervening episodes of serious complications, and dying suddenly somewhere along the way.

The Health Care System Environment

• While the U.S. health care system was well-designed to ensure that surgery and other basic services are readily available, it is less well equipped to meet the needs of people who require medications and home health aides when they face an eventually fatal chronic illness.
• While Medicare provides reasonably well for procedures and hospitalizations, it mostly does not pay for patient and family education for self-care, medications, caregiver supports, or continuity.
• Although more than half of cancer patients dying while covered by Medicare use hospice and are generally treated to unusually coordinated and comprehensive care, too often patients are not eligible for hospice, since their prognosis is too uncertain until just the last few days.

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