This book aims to equip readers with the best available advice on how to make substantial improvements in the health care
system so that it serves the seriously ill person who is coming to the end of life. And that’s just what it does.
This book is the result of a year-long collaborative project, co-sponsored by the Center to Improve Care of the Dying and the Institute for Healthcare Improvement, that included more than
four dozen health care organisations committed to changing practices for the sake of real quality improvement in end-of-life care.
Part I provides an overview of continuous quality improvement.
The chapter on how to go about making improvement happen is an inspiring discussion of what’s necessary, what’s not, and the common pitfalls to avoid.
Part II discusses improving the assessment and treatment of pain, dyspnoea, advanced care planning,
supporting patients and families, and continuity of care. There are numerous illustrative examples from health services around North America ,
setting out the steps they took to achieve improvement. Besides the common mistakes listed in the first part, it might have been useful to describe
some of the projects that didn’t work and why.
Part III is about organisational arrangements that promote quality improvement and Part IV describes
opportunities for improvement in specific diseases - Alzheimer’s, cancer, depression and delirium, and heart and lung failure. The last chapter “Getting
Started” is a summary of what you need to do to get your program started - by next Tuesday!
This is an excellent resource and should be required reading for anyone in palliative care who
is interested in improving any aspect of the care they give to patients and families. Which should be everyone except those who already run a perfect
service. It is well written and immensely practical. Reading it leaves you feeling motivated to get out
there and do something - this week!
Highly recommended.
Roger Woodruff,
Director of Palliative Care, Austin & Repatriation Medical Centre, Melbourne ,
Australia
(June 2002)
Author Information
Joanne Lynn is Director of the Center to Improve Care of the Dying in
Virginia , USA
Janice Lynch-Schuster is Senior Writer, Americans for Better Care of the Dying,
Washington DC , USA
Andrea Kabcenell was Director of eight of the Institute for Healthcare Improvements’ Collaborative
Projects and is a Senior Research Associate at Cornell University,
New York , USA
TABLE OF CONTENTS
Part I: Overview
1. Introduction: Continuous quality improvement for better end-of-life care 3
2. How to make improvement happen 11
Part II - Improved patient care through improved practice and systems
3. Preventing, assessing and treating pain 37
4. Managing dyspnoea and ventilator withdrawal 59
5. Beyond the living will: advanced care planning for all stages of health and disease
73
6. Relationships, spirituality and bereavement: supporting people in difficult times 91
7. Continuity of care: improving patient confidence in the health care system 113
Part III - Arrangements to promote reform
8. Hospital-based palliative care consults and units 133
9. Medicare reimbursement 151
10. Beyond number crunching: ways to use information systems in quality improvement 169
11. Caring for caregivers: helping staff to provide good care 179
12. Using law and policy to improve end-of-life care 191
Part IV - Opportunities and specific diseases
13. Alzheimer’s and other dementias: opportunities to honour life 215
14. Opportunities to improve care for cancer patients 235
15. Depression and delirium 245
16. Offering end-of-life services to patients with advanced heart or lung failure 257
17. Conclusion: Getting started 269
Appendix: Instruments (measurement tools) 277
Resources 327
Index 361
