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Measuring Quality of Care at the End of Life
Molla S. Donaldson, MS;
Marilyn J. Field, PhD
Arch Intern Med. 1998;158:121-128.
Caring for patients at the end of life presents a series of quality-of-care problems to the health care system. In the past, concern has focused on overaggressive treatment of dying patients. Given rapid changes in the financing and delivery of care, it is time to focus on a range of quality problems and address ways to improve care and achieve outcomes desired by patients and their families. We provide a framework for conceptualizing such a task. This article addresses the purposes of measurement, definition of the patient population, timing of measurement, use of surrogates in measurement, scope of services to be evaluated, and the choice of measures. It emphasizes the necessary links between quality measurement and quality improvement.
From the Division of Health Care Services, Institute of Medicine, Washington, DC (Ms Donaldson and Dr Field), and the Department of Health Care Sciences, The George Washington University School of Medicine and Allied Health, Washington, DC (Ms Donaldson).
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