Thursday, April 29, 2010

How Do They Do That? - Providing High-Value Late-Life Care

More than 10 years ago, the Robert Wood Johnson Foundation funded a study that analyzed Americans' values, opinions and attitudes concerning end-of-life care. Based on in-depth focus group discussions involving 385 Americans in thirty-two cities as well as two sets of follow-up interviews, The Quest to Die with Dignity identified how Americans then thought about death and dying, how they want to be treated, and how they viewed planning documents such as living wills.

Some suggest that those participating in the study share similar, clearly articulated concerns, hopes and beliefs about the process of dying in America today. Dying well, for most of these Americans, means dying pain-free, relieved from all suffering. For many, it means dying at home, surrounded by loved ones, and untethered to machines.

Are there communities that do a better job of complying with patient preferences? Communities that could be considered "bellwethers" or "exemplars", communities where high-value late-life care is provided? Using data drawn from the Dartmouth Medical Atlas, such communities can be identified.

Recently, the Institute for Health Care Improvement(IHI), an organization led by Don Berwick, MD, who will soon be leading CMS, identified ten communities where high-value care is being provided. We've taken a look at those communities, to analyze whether there's a connection between their success stories in providing high-value health care and their performance around late-life care. and we've found that some regions do provide high-value health care and patient-centered late-life care.

A previous post on this blog took a closer look at Asheville, North Carolina, one of 10 communities identifed by IHI in their How Did They Do That? study. Among the lessons from the IHI study:

Some patterns: a culture of collaboration to put patients first; considering finances as a constraint, not a goal; the importance of physician leadership; the real or virtual integration of delivery systems across the continuum of care; the importance of strong primary care; the value of electronic health records and the information-sharing it makes possible; and an emphasis on measuring and reporting data on quality and utilization.

We'll take a closer look at some of these communities, in an effort to better understand why some regions' late-life practices produce outcomes that match patient preferences better than other regions.

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