title: "Serious and complex illness" in quality improvement and policy reform for end-of-life care.
abstract: Americans are living longer - a mark of success in public health and medical care - but more will live the last few years with progressive illness and disability. The dominant conception of care delivery separates "aggressive" or life-extending care from "palliative" or death-accepting care, with an assumed "transition" between them. The physiology and the experience of this population are mismatched in this model. Here, we propose a more useful category for public policy and clinical quality improvement: persons who will die as a result of "serious and complex illness." Delivery system changes could ensure reliable, continuous, and competent care to this population.
authors.affiliation: RAND Center to Improve Care of the Dying Arlington, VA 22202, USA. JLynn@rand.org
authors.forename: J
authors.initials: J
authors.lastname: Lynn
authors.forename: J H
authors.initials: JH
authors.lastname: Forlini
mesh_terms: D002908:Chronic Disease / Q000145:classification*; D003266:Continuity of Patient Care; D006291:Health Policy; D006801:Humans; D011787:Quality of Health Care; D012720:Severity of Illness Index; D013727:Terminal Care / Q000145:classification* / Q000592:standards*; D014481:United States