In a time when the nation's health care system is still unrefined, dying persons and their families are forced to confront numerous problems; among the worst are huge medical bills, isolation, fear, and little to no coordination among the services and care provided. As more and more people suffer from chronic illnesses that prolong the dying process, the need for an effective code of treatment for terminally ill and dying patients grows substantially. This sourcebook attempts to fill that need.

At last we have a comprehensive and authoritative guide to how to make quality improvement for end of life care happen within health care systems. Written specifically for use by health care managers and clinicians, this practical guide offers direct, sensible advice that can help you improve quality in your hospital, hospice, nursing home, or other health care facility. The authors include some of the world's leading authorities in the field. This results-oriented guide to how to make change should be read by every medical professional working in a palliative care setting.
Joanne Lynn, M.D. is Director of the Center To Improve Care of the Dying.

• TABLE OF CONTENTS
  
  
• Part I: OVERVIEW
• Introduction: Continuous Quality Improvement for Better End-of-life Care
• How to Make Improvement Happen
  
  
• Part II: IMPROVED PATIENT CARE THROUGH IMPROVED PRACTICE AND SYSTEMS
• Preventing, Assessing, and Treating Pain
• Managing Dyspnea and Ventilator Withdrawl
• Beyond the Living Will: Advance Care Planning for All Stages of Health and Disease
• Relationships, Spirituality, and Bereavement: Supporting People in Difficult Times
• Continuity of Care: Improving Patient Confidence in the Health Care System
  
  
• Part III: ARRANGEMENTS TO PROMOTE REFORM
• Hospital-Based Palliative Care Consults and Units
• Medicare Reimbursement
• Beyond Number Crunching: Ways to Use Information Systems in Quality Improvement
• Caring for Caregivers: Helping Staff to Provide Good Care
• Using Law and Policy to Improve End-of-Life Care
  
  
• Part IV: OPPORTUNITIES IN SPECIFIC DISEASES
• Alzheimer's and Other Dementias: Opportunities to Honor Life
• Opportunities to Improve Care for Cancer Patients
• Depression and Delirium
• Offering End-of-Life Services to Patients with Advanced Heart of Lung Failure
  
  
• Conclusion: Getting Started
• Appendix: Instruments
• Instruments to Measure Quality
• -- Standards of Palliative Care
• Instruments to Assess Pain and Physical Symptoms
• -- Pain Assessment Tool
• Instruments to Assess Survival Time and Aggressiveness of Care
• --Aggressiveness of Care Plan Discussion Documentation Sheet
• Instruments to Assess Spirituality
• Instruments to Assess Grief
• Additional Instruments to Measure Quality
• Multidimensional Instruments
• -- HealthPartners Comfort Assessment
• -- Parkland Hospital Referral Flowchart and Intake Form
• -- End-of-Life Chart Review
• -- After-Death Family Interview
• Resources
• Five Wishes
• Elements of Care Checklist
• Precepts of Palliative Care
• Hospice Interdisciplinary Clinical Competencies
• Glossary
• References
• Index