Structured advance planning. Is it finally time for physician action and reimbursement?
The field of advance directives has come a long way. It has further to go, and like other new interventions in medicine, it will continue to evolve. It probably is now ready for initiatives aimed at widespread use. An immediate agenda for action might look something like the following: (1) encouraging ambulatory care physicians to cosign advance care documents, (2) providing validated worksheets by institutions for ready office and ward use, (3) educating physicians in how to conduct advance planning, and (4) including advance planning discussions in reimbursement systems. Additional moves should include adjustment of medical law to reflect two categories of incompetence and further research on advance care planning to ensure continuing improvement.
Emanuel
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Division of Medical Ethics, Harvard Medical School, Boston, Mass 02115, USA.
D032722:Advance Care Planning; D016223:Advance Directives / Q000639:trends; D018864:Cultural Diversity; D006739:Hospital Administration; D010347:Patient Care Planning / Q000191:economics; D011050:Policy Making; D012051:Reimbursement Mechanisms