"Serious and complex illness" in quality improvement and policy reform for end-of-life care

J Gen Intern Med. 2001 May;16(5):315-9. doi: 10.1046/j.1525-1497.2001.90901.x.


Americans are living longer - a mark of success in public health and medical care - but more will live the last few years with progressive illness and disability. The dominant conception of care delivery separates "aggressive" or life-extending care from "palliative" or death-accepting care, with an assumed "transition" between them. The physiology and the experience of this population are mismatched in this model. Here, we propose a more useful category for public policy and clinical quality improvement: persons who will die as a result of "serious and complex illness." Delivery system changes could ensure reliable, continuous, and competent care to this population.

MeSH terms

  • Chronic Disease / classification*
  • Continuity of Patient Care
  • Health Policy*
  • Humans
  • Quality of Health Care*
  • Severity of Illness Index
  • Terminal Care / classification*
  • Terminal Care / standards*
  • United States