Skip Navigation

Center for Health Services and Outcomes Research

Patient Outcomes – Other Outcomes

Improving Health Care and Palliative Care for Advanced and Serious Illness

We conducted a review of interventions to improve care and outcomes in patients with advanced and serious illness with the objective of evaluating their effectiveness on patient-centered outcomes relative to palliative care, including quality improvement interventions. The review focused on targets related to palliative care, including pain; communication and decision-making; continuity, coordination and transitions of care; and patient and family distress.  We found the most consistent evidence of effectiveness in a large number of studies for the effectiveness of interventions targeting continuity for improvement in patient satisfaction, targeting pain, and targeting communication and decision-making in the intensive care setting.  The evidence has multiple gaps, including studies in illnesses other than cancer for symptom management, in pediatric populations and hospice settings, and addressing diverse populations and disparities in care.

Publications:

Dy SM, Aslakson R, Wilson RF, Fawole OA, et al. (2012) Improving Health Care and Palliative Care for Advanced and Serious Illness.  Closing the Quality Gap: Revisiting the State of the Science. Evidence Report No. 208.  AHRQ Publication No. 12(13)-E014-EF. Rockville, MD: Agency for Healthcare Research and Quality, October 2012.   www.effectivehealthcare.ahrq.gov/reports/final.cfm

Fawole OA, Dy SM, Wilson RF, Lau DB, et al. (2013)  A systematic review of communication quality improvement interventions for patients with advanced and serious illness.  Journal of General Internal Medicine, 28:570-577.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599019/