RECENT DATA1- 4 suggested that the current health care system is providing inadequate care for dying patients, and numerous organizations5- 8 have called for improvements in end-of-life care. It was proposed that external quality measures could be used to improve care at the end of life9- 11 by holding health care organizations accountable for quality medical care for dying patients and by allowing consumers to use the results of these measures to choose among different health care plans. Others6,9,12 focused efforts on identifying domains relevant to this patient population (see Table 1 for examples) and on developing and identifying instruments to assess specific outcomes within these domains for quality improvement efforts.6,10,13- 15 In this article, we argue that end-of-life care is fundamentally different from other medical care that is measurable by existing quality indicators. To expect measurable improvements across multiple domains in a process as complex and variable as end-of-life care either by external quality measures or through internal quality improvement efforts is optimistic at present. Many of the domains identified as candidates for measurement in end-of-life care have never been shown to be improvable by interventions available to health care professionals and organizations. Efforts to improve the quality of end-of-life care should be focused specifically on identifying and measuring those outcomes that are known to be amenable to change and on improving processes of care that are known to affect these outcomes.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 42
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Users' Guides to the Medical Literature
Chapter e23. How to Use an Article About Quality Improvement
All results at
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.