Wednesday, January 23, 2013

Expert Ideas Without Implementation


Care of Americans in their finals months is getting significant and promising attention. 

On January 29 and 30, a summit of national leaders meet in Washington, D.C., as the Coalition to Transform Advanced Care. Less than a month later, the newly formed Committee on Transforming End-of-Life Care, meets in Washington for the first time.

What might be accomplished? And how soon?

The answer may be in Massachusetts, but it’s an answer in progress. 

“I am truly baffled,” Dr. Lachlan Forrow, director of ethics and palliative care programs at Beth Israel Deaconess Medical Center, told the Boston Globe. “We are making practical recommendations for everyone to be taken care of in the way he or she would want to be.”

Forrow chaired an expert panel that studied end-of-life care and recommended ways for the state to improve treatment of the dying. They produced an impressive document. It is now two years old. To date, what guidance it provided largely has gone the way of the Institute of Medicine’s forerunner to the new Committee on Transforming End-of-Life Care.

That committee produced the 1997 report “Approaching Death: Improving Care at the End of Life.” 

The Committee on Transforming End-of-Life Care begins with awareness both of that earlier committee’s good work and how it was largely ignored.These issues are not new,” the IOM website notes 16 years later. “While the 1997 IOM Report made important and wide sweeping recommendations, progress in implementing them has been slow.”

Forrow’s interview was part of a Boston Globe story about dying in Massachusetts. “Precious final days for many Massachusetts residents are still not spent the way they would have chosen -- at home with loved ones -- but in a hospital,” reporter Kay Lazar wrote. 

The story offers a good analysis of why valuable information doesn’t get through to patients and their families (in part because dying is a difficult subject for some to discuss and others to hear), and presents ideas for improving that communication, including the use of video.

Recommendations in the report by Forrow’s expert panel deserve to be acted upon, including communication training for caregivers, and accountability for such training with the state.

Just as “Romneycare” in Massachusetts inspired “Obamacare” nationally, perhaps the Massachusetts expert panel can serve as a model for the experts gathering in Washington, DC over the next month.

Including, one would hope, implementation.

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