Reforming care for persons near the end of life: the promise of quality improvement

Ann Intern Med. 2002 Jul 16;137(2):117-22. doi: 10.7326/0003-4819-137-2-200207160-00010.


Most people in developed countries will live with a serious, eventually fatal, chronic condition for months or years before dying; yet, the delivery of health care services has only just recently begun adapting to this reality. Quality improvement methods have been effective in helping clinical services to make substantial changes quickly. Quality improvement requires stating an aim, measuring success, and testing possible improvements. The testing of changes requires a clinical team to Plan, Do, Study, and Act on new insights (the "PDSA cycle"). Repeated PDSA cycles generate deep understanding of complex systems and make sustainable improvements rapidly. This paper discusses a composite case study in a nursing home setting, which builds on experience with multisite collaborative efforts and introduces quality improvement methods in the context of end-of-life care.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Advance Directives*
  • Aged
  • Aged, 80 and over
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / standards
  • Female
  • Health Care Reform*
  • Homes for the Aged / organization & administration
  • Homes for the Aged / standards
  • Humans
  • Nursing Homes / organization & administration
  • Nursing Homes / standards
  • Patient Care Team / organization & administration
  • Quality Assurance, Health Care*
  • Terminal Care / standards*
  • United States