End-of-life collaborative seeks breakthrough’
Connecting science to practice in real world
The latest health policy body to turn its attention to shortcomings in care at the end of life is the Boston-based Institute for Healthcare Improvement (IHI), a nonprofit quality improvement organization formed to help bridge the gap between best scientific knowledge and prevailing practice in health care.
IHI’s "breakthrough series" of collaboratives aim to promote rapid improvements in health care quality by bringing providers together around hot topics such as cesarean rates, cardiac surgery, and intensive care, in order to achieve lower overall costs and better outcomes from care.
Knowledge gaps remain in health care system
"There are many areas where the scientific knowledge base provides tremendously powerful ideas for improving care, but out in the larger health care system there are remarkable gaps," IHI president and CEO Donald M. Berwick, MD, explains. "It’s not a plot [by providers]; the problem has to do with change and how to achieve changes in health care institutions. It’s not enough just to measure the problem. We need a machine to take what we know and put it to use," Berwick says.
Care of the dying is "in urgent need of repair," asserts a recent press release from IHI. The organization hopes to improve this picture by convening a one-year intensive collaborative with teams from 20 to 40 health care institutions, beginning later this month. The project will focus on improving pain and symptom management, advance directive planning, transfers between providers and settings, and support for the families of dying patients.
Change must come within organizations
Participating organizations pledge their commitment to actively work on change within their institution. They will go through three cycles of meeting with experts in the field to identify barriers to the use of existing knowledge, then returning to their institutions to try to implement these ideas. IHI collaboratives aim to spark major rapid changes, based on the best available data and most effective strategies for realizing change within institutions. At the end of the year, a national congress will be held to share results and learning from the collaborative.
Chairing the end-of-life collaborative is Joanne Lynn, MD, head of the Center to Improve Care of the Dying at George Washington University in Washington, DC. The planning committee includes four physicians, a statistician, and Carolyn Cassin, MPA, CEO of Hospice of Michigan. Participating organizations commit a three-member team and $12,000 to the collaborative, as well as resource support and active senior leadership involvement back at home.
Funds are available for those who cannot afford to pay for the end-of-life collaborative. The application deadline is nearing, with the first meeting scheduled for July 20-22 in Landsdowne, VA.
[Editor’s note: For more information, contact IHI at 135 Francis St., Boston, MA 02219. Telephone: (617) 754-4800.]
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