Leonard D. Schaeffer: "Can Our Health Care System Provide a ‘Good Death’?" 9.29.16
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Transcript of Leonard D. Schaeffer: "Can Our Health Care System Provide a ‘Good Death’?" 9.29.16
Leonard D. Schaeffer Judge Robert Maclay Widney Chair and Professor, University of Southern California
September 29, 2016
Health Matters Webinar: Can Our Health Care System Provide a “Good Death”?
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• In last century, death has evolved from a family event to a medical event
• Many die in circumstances that do not reflect their values or preferences
• A more culturally diverse population means clinicians cannot make assumptions about the care choices patients might make
• A fragmented care delivery system with perverse financial incentives contributes to uncoordinated care and unnecessary costs
Dying in America (DIA): Why Improve End-of-Life Care?
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1. Delivery of person-centered, family-oriented care
2. Clinician-patient communication and advance care planning
3. Professional education and development
4. Policies and payment systems
5. Public education and engagement
DIA Recommends Change in 5 Key Areas to Transform End-of-Life Care
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What Does DIA Recommend?
1. Delivery of person-centered, family-oriented care
• Health care delivery organizations should provide integrated, person-centered, family-oriented and consistently accessible care near end of life
• Government and private health insurers should cover and pay for these services
• Care should be transparent and accountable through public reporting of quality and costs
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• The advance care planning process should center on frequent conversations with patients, family members and providers and should be electronically stored
• Professional societies and other organizations should develop standards for clinician–patient communication and advance care planning
• Payers and health care delivery organizations should adopt these standards
What Does DIA Recommend?
2. Clinician-Patient Communication and Advance Care Planning
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• Educational institutions, professional societies, accrediting organizations, certifying bodies, health care delivery organizations and medical centers should:
Ø Establish training, certification, and/or licensure requirements for palliative care knowledge/skills
Ø Increase the number of palliative care specialists
Ø Expand the knowledge base for all clinicians
What Does DIA Recommend?
3. Professional Education & Development
• Payment systems should undergo a major reorientation to incentivize: Ø Integration of medical and social services
Ø Coordination of care across multiple care settings
Ø Use of advance care planning and shared decision making
• Congress should enact legislative changes if necessary
• Federal government should require public reporting on quality measures, outcomes, and costs of care near end of life for its programs
What Does DIA Recommend?
4. Policies & Payment Systems
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• Public education and engagement about end-of-life care planning is needed at the societal, community and family, and individual levels
• A range of organizations should engage constituents and provide fact-based information about care to encourage advance care planning and informed choice
• Disseminating accurate information is critical to ensure individual care decisions are based on fact
What Does DIA Recommend?
5. Public Education & Engagement
If DIA Recommendations Were Implemented: What Would End-of-Life Care Look Like?
Patients Respected
• Medical and social services would reflect patients’ values, goals, preferences and condition, and allow for their needs and service intensity to change over time
Crises Prevented
• Comprehensive, person-centered and family-oriented care would reduce preventable crises, repeated 911 calls, ER visits, and hospital admissions
Costs Stabilized
• High-quality patient-centered care could help stabilize aggregate societal expenditures for medical and social services, and potentially lowers their costs
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ü Public is way ahead of policymakers, health care organizations and the media on this issue…
ü Many Americans have had a difficult experience with the final days of a family member or dear friend…
ü Dying in America report captures the human interest and the data, and provides a roadmap for change…
A movement to change how we die is underway: journalists can educate the public about policy & personal
options to help accelerate cultural and systemic change
Opportunity for Journalists: Everybody Has a Story