Improving Access to Palliative Care through an Innovative Quality Improvement Initiative: An Opportunity for Pay-for-Performance

Abstract

Quality improvement strategies that incorporate pay-for-performance incentives can be used effectively to expand palliative care services to underserved populations.

Factors Predicting Bereaved Caregiver Perception of Quality of Care in the Final Week of Life: Implications for Health Care Providers

“…Such measures might include standardized team-family meetings to clarify goals of care, development of triggers for palliative care consultation, adherence to established professional EOL care guidelines, proactive consultation of clinical social workers and chaplains, and promotion of generalist palliative care competencies across all disciplines. [58][59][60][61][62] For patients who cannot leave the hospital, teams should be identifying ways to make inhospital care feel more peaceful and dignified (e.g., 24-hour family access, private hospital rooms) and developing policies to ensure high-quality EOL care in the acute care setting (e.g., protocols for ventilator withdrawal and palliative sedation).…”

Promoting further use of palliative care in cancer care centers

“…Triggers for referral to palliative care have been developed based on symptoms or sentinel events but such guidelines often look like criteria for hospice referral rather than for early palliative care [62] Similar triggers and guidelines have been developed for inpatient referrals which are based on symptoms or events as a means of involving palliative specialist in crisis management [63,64]. These guidelines if used in the outpatient setting would lead to late referrals.…”

Early Specialty Palliative Care

“…Although oncologists agree that early referral to palliative care is ideal, studies consistently show that patients continue to be referred late, often close to the end of life, and only after all anticancer treatments have been exhausted. 4 Palliative care training for medical oncologists has the potential to improve this trend. Since 2003, the European So-ciety for Medical Oncology has been leading the way by formally accrediting centers of integrated oncology and palliative care.…”

“…3 An age-associated lack of PGC-1α induction has also been reported in the skeletal muscle of old animals. 4 The transgenic overexpression of PGC-1α efficiently prevents sarcopenia in old mice by limiting the degradation of muscle proteasome and apoptosis. 5 All these facts highlight the role of most mitochondrial proteins, and probably those involved in mitochondrial fission and fusion, in the loss of muscle mass associated with aging and emphasize the importance of mitochondria as targets for pharmacologic interventions intended to prevent sarcopenia.…”