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EXECUTIVE SUMMARIES OF THE CONFERENCES
Executive Summary of the First TIME Conference -- August 27-28, 1996 Summary by Joan Teno, M.D., M.S. Brown University Center for Gerontology and Health Care ResearchPhysician assisted suicide has become an issue of increasing public concern and media attention. A central portion of court cases has focused on individual rights. It has been argued that an important aspect of this debate ought to be how well our hospitals and other health systems care for dying patients. Drs. Melinda Lee and Susan Tolle have noted that the "silver lining" of this debate may be the stimulus for health care institutions to examine the quality of care for dying and seriously ill patients. The aim of this conference was to provide health care institutions with a resource guide (a "toolkit") that would allow them to examine and improve their quality of care for dying patients and their families. With funding support from the Nathan Cummings Foundation and the Robert Wood Johnson Foundation, a multidisciplinary group of 27 persons assembled to review current knowledge about measuring quality of care at the end of life, make recommendations about the use of existing measures, and outline important issues that need urgent work for the vision of the "toolkit" to go forward. Deming stated that, "If you don't measure it, you can't improve it." Our ultimate vision for the "toolkit" was that health care institutions be able to use the "toolkit" to examine care of the dying, identify opportunities for improvement, and then undertake interventions to improve and enhance the quality of care. The results of this conference represent an early effort to review existing instruments to examine the quality of care for dying persons and their families. This executive summary briefly summarizes the vision for the toolkit and outlines important research and design questions that we encourage both grant funders and researchers consider in the design of future measures to examine quality of care at the end of life. Vision for Measures included in the Toolkit 1. Measures
must be clinically meaningful and manageable in their application.
The ultimate
use of these measures will be for quality improvement. In the future,
with experience with the measures, development of guidelines, and research,
the use of these measurements will be extended to informing the consumer
and purchasers of health care. 5.
What is the cost effectiveness of various strategies to get information
on the quality of care? 6.
How are the respondents' views influenced by the wording and location
of the question in the survey? Executive Summary of the Second TIME Conference -- September 28-30, 1997 The following summary is adapted from the conference white paper.
Despite the universality of death and recent national concerns about care at the end of life, little attention has been given to developing the conceptual models, measurement tools, and evidence base necessary for achieving quality medical care and quality of life of dying patients and their loved ones. The overarching goal of this second TIME conference was to develop a research agenda for measuring quality of care and quality of life for persons diagnosed with a life-limiting illnesses and for persons who are in the process of "actively dying." More specifically, the task presented for this conference was to reach accord on the following three key questions: 1. What are the goals of a Toolkit of Instruments to Measure End of Life Care?
2. Based on the current conceptual models of quality of care and quality of life, what are the important domains in which existing measures need to be refined or new measures developed? Ideally, measures should be developed from existing standardsespecially when applied for purposes of accountabilityand those standards should be based on accurate empirical information from descriptive and experimental research. Choice of domains should reflect the consumer viewpoint. Focus groups and in-depth interviews with seriously ill patients, their families, and surviving loved ones can properly guide selection of priority domains. Furthermore, measures should be synergistic with ongoing work in the development of guidelines and standards. 3. What empirical research is needed to address the validity of proposed measures, potential sources of information about the quality of care and quality of life, and implementation of measurement tools in health care systems?
Along with the white paper, other articles resulting from this conference are published in a special issue of Journal of Pain and Symptom Management (1999 February; Volume 17, No. 2). These articles include: Byock IR. Conceptual Models and the Outcomes of Caring. (pp. 83-92) Stewart AL, Teno J, Patrick DL, Lynn J. The Concept of Quality of Life of Dying Persons in the Context of Health Care. (pp. 93-108) Teno JM, Coppola KM. For Every Numerator, You Need a Denominator: A Simple Statement But Key to Measuring the Quality of Care of the "Dying". (pp. 109-113) Fowler FJ, Coppola KM, Teno JM. Methodological Challenges for Measuring Quality of Care at the End of Life. (pp. 114-119) Executive Summary of the Third TIME Conference -- June 15-17 2000 Not currently available. Please check back periodically.
Questions?
Contact Dr. Joan Teno via email at Brown University. |
This web site is published by the Center for Gerontology and Health Care Research, Brown Medical School. For further information, e-mail Dr. Joan Teno or contact her at Brown Medical School, Box G-HLL, Providence, RI, 02912, USA. For questions or comments regarding this website, please e-mail the webmaster. Last edited February 17, 2004. |