Wednesday, September 17, 2014

New IOM Report: Dying in America - Improving Quality and Honoring Individual Preferences Near the End of Life

Today, the Institute of Medicine released a new report called "Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life." I had the pleasure of serving on the committee for the past 18 months*, which makes me so excited to finally share this report publicly. I hope you will all join the wider health care community in dissecting, analyzing, and disseminating this report.  Without your involvement from this point forward, this will merely be an impotent academic exercise.

Nothing in this report should be shockingly new to anyone in hospice and palliative care (HPC), but you now have this a tool to construct an exciting future where more people get excellent whole person care. All the organizations we work with (especially those outside of HPC and outside of health care) need to understand the recommendations and work to try an implement them locally and systematically. We are a large voice, but we are barely speaking as one.  NHPCO via Hospice Action Network and AAHPM have some great resources on how to work with your local and federal legislators. Let them know you read this and it is important to you!  Share what you find important about this report with your friends and family.

The key areas covered include:

  • Delivery of person-centered, family-oriented care
  • Clinician-patient communication and advance care planning
  • Professional education and development
  • Policies and payment systems
  • Public education and engagement
Two of the most interesting issues to me in this report, are 1) the call to payers and policy makers to integrate medical and social services and the 2) the emphasis on teaching primary palliative skills to all disciplines and specialties.  We can't get to major change with out reforming how the money flows through the system and incentives action over communication, and we as specialists can't satisfy all the palliative care needs in the system, so we need to ensure a basic palliative skill set for all health care providers.

The last major reports were in 1998 (Approaching Death: Improving Care at the End of Life) and 2002 (When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families) and they helped spur a great growth in palliative care as a specialty for physicians.  We have a tent pole now it is time to raise the roof.

Major articles featuring the IOM report (will be updated- check back):
New York Times - End-of-life Care needs Sweeping Overhaul, Panel Says
Kaiser Health News - Dying in America is Harder Than It Has To be, IOM Advises
Science 2.0 - US Health System Doesn't Think About End of Life Care - Yet
Business Insider - US Needs Better End-of-Life Care, Which Might Cut Costs: Study
Washington Post (blog) - It's Time to bury the 'death panel' myth for good. Is this the way to do it?
the kb Group (blog) - The New IOM Report on Dying in America
Geripal (blog) - New IOM Report on Dying in America
Forbes (blog) - Reimagining End of Life Care

*In case you have not been a long time reader, you may not know that I highlighted some potential gaps in the IOM committee when it was first announced in January 2013. While it was not meant as a means to get on the IOM committee (I applied the normal way and was initially not selected), some people put in my name to the IOM, and they added me as a member in February 2013.  It was really a fantastic experience and I learned so much from the many smart people on the committee. I would have loved to write about it while I went through it and share it with all of you, but the IOM review process stresses impartiality and confidentiality as you build the report. But now the report is out in the wild and I hope you will join me in spreading this important information.

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