IMPROVEMENTS & INNOVATIONS IN END OF LIFE CARE

2001年2月11日至13日，RAND/健康改善倡议研究所将在乔治亚州亚特兰大主办一次关于改善临终关怀质量的全国大会。美国人现在很可能会在最终会杀死他们的疾病中生活几个月甚至几年，比如晚期心脏病和肺病、中风、痴呆和许多癌症。这些人中的许多人在此期间残疾，往往会经历严重并发症的发作，死亡发生在一个不可预测的时间。我们目前以急症护理为中心的交付和支付系统并不是为了以协调或富有同情心的方式满足这些人的独特需求而设计的。尽管存在这些挑战，但在一些环境中，向这一人群提供的护理正在得到改善。然而，这些改善大多是通过轶事传播，并通过非传统的媒介传播，而不是在主流的医学和公共卫生文献中传播。这一领域缺乏知识“家园”阻碍了质量改进技术的广泛采用。兰德/国际艾滋病倡议与其他有决心的组织一道，正在努力克服这些障碍。全国大会的三个目的是：1)广泛传播我们和其他人所了解到的关于临终关怀质量改善的最佳实践和研究成果的信息，并为新的见解和学习创造一系列机会，甚至在会议上；2)利用会议的动态为参与的提供者组织内部和之间的临床护理相关协作和信息共享提供基础，确保会议结束后参与者在工作中获得的见解得到快速传播；3)正式启动新的RAND/Institute for Healthcare Improvement Initiative to Improve at the End Life，该倡议致力于支持创新和评估实践，这对于创建一个临终患者可以依赖的护理系统至关重要。会议的预期短期成果将是增加与会者对已被证明的最佳实践和研究成果的了解，他们可以应用这些实践和研究成果，以快速、可衡量地改善他们为生命垂危或接近生命终点的患者提供的护理。此外，我们希望帮助参与者从仅仅对质量改进的好奇转变为真正的动机、准备和信心，他们可以回到他们的实践地点，准备好自己参与到过程中来。大会将包括一系列活动，以满足不同学习方式的参与者的需求，包括大型小组讲座式学习（全体会议）、小型小组教学（分组会议）、一对一讨论和信息支持（故事板）以及小型小组互动（午餐讨论桌）。

The RAND/Institute for Health Improvement Initiative to Improve Quality at the End of Life will host a National Congress on Qualitative Improvement in End of Life Care on February 11-13,2001 in Atlanta, Georgia. Americans are now likely to live for months of years with the diseases that will eventually kill them, such as advanced heart and lung disease, stroke, dementia, and many cancers. Many of these individuals are disabled during this period and tend to experience episodes of serious complications, with death occurring at an unpredictable time somewhere along the way. Our present acute care-centered delivery and payment systems are not designed to meet the unique needs of these individuals in a coordinated-or compassionate manner. Despite these challenges improvements in the care delivered to this population are being made in a number of settings. However, word of these improvements has mostly been spread anecdotally and has been disseminated through non- traditional vehicles, rather than in the mainstream medial and public health literature. This lack of an intellectual "home" for the field has prevented the wider adoption of quality improvement techniques. The RAND/IHI Initiative, along with other committed organizations, is working to surmount these barriers. The three-fold purpose of the National Congress is to: 1) Widely disseminate information about what we and others have learned about best practices and research findings related to quality improvement in end of life care and create a series of opportunities for new insights and learning, even at the conference; 2) Use the dynamic of the conference to provide the basis for collaboration and information sharing related to clinical care within and between participating provider organizations, ensuring rapid dissemination of insights learned in the participants' work after the conference; and 3) Formally launch the new RAND/Institute for Healthcare Improvement Initiative to Improve Quality at the End of Life, which is dedicated to supporting the innovation and evaluation practice that is essential to creating a care system that people coming to the end of life can depend on. The intended short-term outcome of the conference will be to increase participants' knowledge about proven best practices and research findings that they can apply to making rapid, measurable improvements in the care that they deliver to patients who are at or near the end of life. In addition, we hope to help participants shift from mere curiosity about quality improvement to a real motivation, readiness, and confidence that they can return to their practice sites ready to become engaged in the process themselves. The Congress will include a combination of activities to meet the needs of participants with varying learning styles, including large-groups lecture style learning (plenary sessions), small group teaching (breakout sessions), one-one discussion and information support (storyboards), and small group interaction (lunch discussion tables).