Over the next decade, health care delivery and financing will shift from volume- to value-based payments. Hospital leaders, seeking ways to address economic incentives, may find that developing advanced illness management programs will help the transition. Advanced illness, according to the Coalition to Transform Advanced Care, is one or more conditions serious enough that general health and functioning are declining and treatments begin to lose their impact — a process that continues to the end of life.
Managing advanced illness can make the difference in patient experience. Not only are hospitals uniquely positioned to integrate AIM programs into the continuum of care, but studies show that well-developed programs improve quality of life, lower utilization of treatments and hospital admissions, improve patient and family satisfaction, and reduce aggregate spending.
Strategies to Deliver High-Quality AIM
Three key strategies to deliver and support high-quality and well-coordinated end-of-life care are:
- increasing access to AIM services;
- raising patient and community awareness and engagement;
- developing a ready, willing and able workforce.
The three key strategies hold equal importance: Increased access to AIM programs can change the way medical services are used. A ready, willing and able workforce can elicit informed end-of-life preferences and deliver high-quality services. And patient and community awareness in advanced illness planning can make a significant difference in both the patient and family experience as life draws to a close.
Access to AIM Services
In 2012, the AHA Committee on Performance Improvement commissioned two reports on AIM. The first focused on how hospitals can increase access to AIM programs. The follow-up report, "Advanced Illness Management Strategies: Engaging the Community and a Ready, Willing and Able Workforce," outlines a program framework that hospitals and health care systems can use to coordinate AIM services with the goal of increasing patient and community awareness and engagement, and developing a ready, willing and able workforce. The report includes case studies that highlight the work of organizations that have successfully launched AIM programs.
Patient and Community Awareness and Engagement
Partnering with AIM programs can make the difference between "dying well" and "dying badly." End-of-life care requires the active involvement of health care providers, patients and their families. Health care providers will need systems and supportive services designed to care for people as they become increasingly less able to tend to themselves, while patients will need to engage and clearly articulate their needs so that providers can deliver the preferred care.
Communitywide strategies can raise awareness significantly in advanced illness planning and attain the best quality of life and support for patients and families facing the end of life.
For example, hospitals can:
- implement internal systems strategies such as collecting information on communication needs and tracking performance of patient engagement programs;
- launch community-engagement programs that align with patient demographics, education levels, culture and language differences;
- support partnerships with local leaders and organizations that cater to their patient population.
Several organizations have launched end-of-life care initiatives that promote patient and community awareness and engagement. The Conversation Project, in partnership with the Institute for Healthcare Improvement, is developing capacity among health care professionals to initiate, elicit, receive and build on conversations with patients facing life-limiting illness, and to create awareness and engagement among individuals. The Coalition to Transform Advanced Care works with diverse organizations and individuals dedicated to transforming advanced illness care and improving the social, policy and health care system environment and norms for quality care.
Ready, Willing and Able Workforce
There is a growing shortage of health care professionals; in addition, some medical and nursing training programs overlook the skills to communicate with patients facing the end of life. To deliver high-quality hospice, palliative and end-of-life care, hospitals must foster or employ the necessary human capital. This involves building a workforce with the knowledge, skills and competency to provide care to patients with advanced illness.
To develop health care professionals who are ready, willing and able, hospitals can:
- create educational programs that offer ongoing training for health care professionals to learn the necessary skills and competencies to engage in sensitive conversations;
- use multicultural guides and spiritual toolkits to support understanding and meet diverse patient needs.
The Sacred Art of Living Center in Bend, Ore., offers workshops for health care providers that incorporate spirituality into clinical care. The Harvard Medical School Center for Palliative Care offers continuing educational opportunities to physicians, nurses and other health care professionals aimed at alleviating suffering and enhancing care of patients facing life-threatening illness.
Rhoby Tio, M.P.P.A., is a program manager for the Health Research & Educational Trust.