Many families of seriously ill patients experience severe caregiving and financial burdens. Families of younger, poorer, and more functionally dependent patients are most likely to report loss of most or all of the family's savings.

BACKGROUND: The purpose of Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) was to improve outcomes for seriously ill hospitalized adults by improving information and decisionmaking. The SUPPORT intervention has been characterized only briefly in previous publications. OBJECTIVE: To characterize the intervention in SUPPORT and its implementation. DESIGN Reports derived from training and administrative materials, quantitative descriptions of implementation activities, and qualitative analysis of narrative reports and focus group participation by the intervention nurses. SE'TTING AND PATIENTS: SUPPORT enrolled 2652 patients in the intervention arm and 2152 in the control arm of a block-randomized trial of enhanced information, counseling, and support. The patients were hospitalized with one of nine serious illnesses in one of five US teaching hospitals between 1992 and 1994. MEASUREMENTS: (1) Reports on training and supervisory materials;(2) Rates of intervention component completion from contact logs and reports completed by the intervention nurses; and (3) grounded theory analysis of patient narratives, overview questionnaires, and focus group transcripts from the intervention nurses. RESULTS: Prognostic reports were delivered on time to the caregiving team in 83% of cases on Day 3. Reports of surrogate interviews of patient preferences and understanding were delivered on time to the caregiving team in 72% of first week cases. Patients' own reports of preferences were unavailable for 56% of cases in the first week. Overall, 39% of the rest of the patients had their interview information delivered on time to the caregiving team. The SUPPORT intervention nurses averaged 8.5 contacts with patients, 7.6 with surrogates, 3.5 with physicians, and 11.7 with other staff. The intervention nurses felt that they were fully involved in 81% of cases and had a limited role in another 14%. The major issues for patients were: understanding their situation, communication and decision-making, advance planning, do not resuscitate orders, and general support, including support for loss and grieving. The narrative sources

Older persons aged more than 80 years can understand a health benefit choice; most liked the aims of a new supportive care benefit, and 34% would change immediately from Medicare to a supportive care benefit such as MediCaring,. These findings encourage further development of special programs of care, such as MediCaring, that prioritize comfort and support for the old old.

Smokers recruited through the medical outpatient clinics of two similar Veterans Hospitals over two successive years participated in a smoking cessation study which randomized them between a group assigned to behavior modification clinics and a group receiving a packet of smoking cessation material in the mail. Following the second year's clinics at the site of one of the two hospitals, an intensive media campaign, based on the content of the behavior modification program, was targeted at the study population over commercial television and radio. The six-month abstinence rate for clinic participants measured by self-report, serum thiocyanate and exhaled air carbon monoxide was 36.8% in the group assigned to clinic followed by media, 20.2% in the group assigned to clinic alone, and 10.6% in the group receiving materials in the mail. The difference in cessation rates between the clinic participants who were and those who were not exposed to the media following their clinics was significant at the 0.05 significance level (chi 2 = 3.9, 1 d.f.). Logistic analysis confirmed the benefit of the media campaign.

The Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention launched the Surgical Infection Prevention Project in 2002. The groups developed performance measures regarding perioperative antibiotic use to prevent surgical site infections. Other organizations have since adopted these measures. Spectrum Health, a not-for-profit health system in western Michigan with seven hospitals, more than 140 service sites, and a 565,000-member health insurance plan, formed an interdisciplinary quality improvement team to meet a goal of 100% adherence at two of its acute care hospitals in the city of Grand Rapids. Eighteen months later, process shifts had been achieved, demonstrating that a comprehensive, interdisciplinary approach can result in consistent perioperative antibiotic utilization.