'Dying in America' IOM Report Calls for Major Reform
Written by Editor   
Tuesday, September 23, 2014 02:47 PM

The US health system needs major reform to ensure high-quality, affordable, and sustainable end-of-life care for Americans, according to a new Institute of Medicine (IOM) report called Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.  The 507-page document reports recommendations developed during the past two years by a 21-member national committee.

"This is one of the most comprehensive and up-to-date studies that has been performed on end-of-life care for people of all ages who are approaching death."  The time is now for our nation to develop a modernized end-of-life care system as envisioned by this report.”

Americans hold "strong" views about the type of care they would like to receive at the end of life. They generally prefer to die at home and with the ability to maintain control over healthcare decisions, according to the report. But there is little, or no, planning put in place. Surveys have suggested that more than 25% of adults, including those aged 75 years and older, have given "no thought" to end-of-life care. "Even fewer" have written down their preferences or talked about them with family or providers, according to the report.  In a system aimed at curative rather than supportive and comfort care, such discussions are crucial to honoring the preferences of dying patients and their families.

The report offers recommendations for improving end-of-life care in five key fields.

  • First, delivery of person-centered, family-oriented end-of-life care should be a priority, the report urges.
  • The second recommendation addresses provider-patient communication and advance-care planning.
  • The third recommendation focuses on professional education and development regarding palliative care.
  • The fourth recommendation pertains to healthcare policies and payment systems. How healthcare dollars are spent needs major reform, according to the committee, with resources directed toward palliative care services.
  • The fifth and final recommendation calls for increased public education and engagement.

"Federal, state, and private insurance and health care delivery programs should integrate the financing of medical and social services to support the provision of quality care consistent with the values, goals, and informed preferences of people with advanced serious illness nearing the end of life," the authors recommend.

They call for legislation, public reporting of quality measures, and financial incentives aimed at improving quality care, care coordination, and shared decision making. Health information technology, they point out, should be used to achieve these goals.

"A palliative approach can offer patients near the end of life and their families the best chance of maintaining the highest possible quality of life for the longest possible time," the report concluded. "The committee believes a patient-centered, family-oriented approach to care near the end of life should be a high national priority and that compassionate, affordable, and effective care for these patients is an achievable goal."

Source:  http://www.medscape.com/viewarticle/831935?nlid=65843_2981&src=wnl_edit_dail&uac=151914AX#2