Experts Say Overhaul Needed on End-of-Life Care

Palliative care such as hospice has become widely accepted among patients and their families when it comes to end-of-life care, but some are saying this type of health care delivery falls short in several places, according to a recent report from the Institute of Medicine (IOM). 

The areas where end-of-life care requires the biggest overhauls include that manner in which palliative care is delivered and coordinated, its policies and payment systems, along with public and professional engagement, says the IOM committee of experts in its report Dying in America.

“Ideally, health care should harmonize with social, psychological, and spiritual support to achieve the highest possible quality of life for people of all ages with serious illnesses or injuries,” writes the IOM committee in a briefing of the report.

Researchers view hospice as an important approach to addressing the palliative care needs of patients with limited life expectancy and their families, as it provides a more “comforting” alternative to technologically elaborate, medically centered interventions, however, several deficiencies persist.

First, the researchers note that recent knowledge gains have not necessarily translated into improved patient care. Second, a small supply of palliative care and hospice specialities force patients to rely on other clinicians who provide care for individuals with serious advanced illness, but who may lack the specific training and experience necessary to meet palliative care needs.

In efforts to address these shortfalls, the committee urges that reform is needed in how resources for care provided near the end-of-life are organized.

Specifically, experts recommend the federal government should require public reporting on quality measures, outcomes and costs regarding the end-of-life care for programs it funds or administers.

Additionally, they also recommend that financial incentives should be provided for medical and social support services that decrease the need for emergency room and acute care services, as well as for coordination of care across settings and providers—from hospital to ambulatory settings as well as home- and community-based settings. 

“High-quality, comprehensive, person-centered, and family-oriented care will help reduce preventable crises that lead to repeated use of 911 calls, emergency department visits, and hospital admissions, and if implemented appropriately, should contribute to stabilizing aggregate societal expenditures for medical and related social services and potentially lowering them over time,” the committee writes. 

The committee also recommends a “major” reorientation of payment systems in efforts to incentivize the integration of medical and social services, as well as the coordination of care across multiple care settings.

Such a reorientation , the committee adds, would not only improve access to services that better respond to the needs of patients and their loved ones, but would also hep stabilize health care costs. 

“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,” recommends the IOM committee. 

But even as palliative care and hospice become more established in the health care landscape, there remains a need for greater understanding of how critical a role these care methods can play in the delivery of high-quality end-of-life care.

“Although American’s values and opinions about end-of-life care will necessarily differ, the committee emphasizes the importance of disseminating accurate information so that individual care decisions and public dialogue, as much as possible, are based on an informed understanding of facts,” the committee concludes.

View a brief of the IOM report. 

Written by Jason Oliva

Jason Oliva

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