Institute of Medicine Releases New Report – Dying in America: Improving Quality and Honoring Individual Preference Near the End of Life

November 4, 2014 10:56 AM

The Institute of Medicine recently released a report, Dying in America:  Improving Quality and Honoring Individual Preference Near the End of Life.  While the report did not have a strong focus on hospice or some of the conditions hospices are dealing with, such as Alzheimer’s, it does provide useful information on the current state of end of life care. 

National palliative care expert Dr. Diane Meier conducted a webinar overview of the report where NAHC’s affiliate Hospice Association of America (HAA) was a participant. Dr. Meier explained how the Institute of Medicine improves general awareness, for the topics on which it reports, among professionals, policy makers, and the general public.  The IoM has made the message clear through this most current report and previous reports that palliative care is essential to quality of life care. 

The Dying in America report was commissioned by “A publicly spirited donor wishing to remain anonymous.”  The donor and the IoM staff developed the following Statement of Task for this report:

Current state of end of life care with respect to:

  • Delivery of medical care and social supports
  • Patient-family-provider communication of values and preferences
  • Advance care planning
  • Health care costs, financing, and reimbursement
  • Education of health professionals, patients and loved ones, and the public at large

After study, the key recommendations of the report are:

  • Person-centered, family-oriented (palliative) care. The recommendation is that integrated, person-centered, family-oriented (palliative) care that is consistently accessible near end of life be provided by all health care delivery organizations and be paid for by all payers.
  • Clinician-patient communication and advance care planning. The recommendation is that advance care planning documents should not take the place of communication.  Professional and quality organizations should develop standards for clinician-patient communicationand advance care planning that are measurable, actionable, and evidence based. Adherence to these standards should be tied to credentialing, licensing, and reimbursement.
  • Professional education and development. The recommendation is for education institutions, professional societies, accrediting organizations, certifying bodies, health care delivery organizations and medical centers establish training, certification, and licensure requirements that strengthen the palliative care knowledge and skills of all clinicianswho care for individuals with advanced serious illness.
  • Policies and payment systems. The IoM found that reform is necessary for how resources for care near the end of life are organized.  The recommendation is federal, state, and private insurance and health care delivery programs should integrate the financing and delivery of medical and social services - and require public reporting of quality and costs for care near the end of life.
  • Public education and engagement. Every element of society - societal level, community and family level, individual level - should engage their constituents and provide factual information about care of people with advanced serious illness to encourage advance care planning and informed choice based on the needs and values of individuals

Dr. Meier stressed the importance of moving palliative care forward by providing guidance and examples of how to do this throughout the webinar.  Based on history and feedback from policy makers, Dr. Meier found that securing a sponsor and having consistent messaging from all stakeholders were two key criteria for change. 

Dr. Meier encourages stakeholders to start by telling the story of palliative care and aligning with and creating coalitions of significance for coordination and alignment of the palliative care message.  In order to impact change, providers and interested parties can actually do many things including collecting outcomes data and working with payers to develop strategies that target and manage high cost patients with serious illness; creating patient care screening tools to identify those who would benefit from advance care planning; providing and requiring training in communication skills and advance care planning, etc. 

The IoM will engage in a 12-month dissemination phase for the Dying in America report that will include materials, stakeholder outreach and evaluating tactics to inform future decision-making.