Center for Patient Safety at the End of Life

兰德改善临终关怀中心将产生一个新的患者安全评估和研究开发中心：临终患者安全中心。该中心将由Joanne Lynn博士领导，并将由来自兰德健康、医疗改善研究所、退伍军人健康管理局、Kaiser Permanente和其他组织的专家组成。这些医疗服务研究和质量改进领域的领导者致力于为患有严重、最终致命慢性疾病的人提供安全可靠的护理，尤其是那些患有晚期慢性心肺衰竭的人。尽管它们有可能影响为所有美国人提供的医疗保健，但医疗差错和患者安全方面的其他失误对年龄最大和病情最重的患者的影响不成比例，无论是在发病率还是在后果的严重性方面。严重的长期疾病大多发生在生命的末期--在一个最需要安全、可靠、协调的护理的人群中，导致更多的错误、不良影响以及不稳定和不安全的治疗患者。重病患者经常会犯一系列重复的错误，包括：没有治疗疼痛、精神错乱和其他症状；提供者计划内和提供者之间的常规中断；照顾的地点是为了提供者的便利，而不是效率或家庭支持；以及缺乏对提前护理计划的关注。该中心旨在通过有效的改变方法和对慢性阻塞性肺疾病慢性心力衰竭患者的安全和正确护理的知识来建设改善能力，从而帮助显著提高医疗保健的可靠性。在第一阶段，中心将建立一支强大的团队，发展与卫生服务系统的联系，制作教育材料，并制定至少一项试点研究的提案，将在第二和第三年进行。在第二阶段，中心将实施试点研究，提供教育材料，并为试点研究结果开展传播。

The RAND Center to Improve Care of the Dying will generate a new Developmental Center for Evaluation and Research in Patient Safety: the Center for Patient Safety at the End of Life. The Center will be led by Dr. Joanne Lynn and will build on experts from RAND Health, the Institute for Healthcare Improvement, The Veterans Health Administration, Kaiser Permanente, and other organizations. These leaders in health services research and quality improvement are committed to making care safe and reliable for persons with serious eventually fatal chronic illness, staring with those with advanced chronic heart or lung failure. Although they have the potential to affect the health care provided to all Americans, medical errors and other lapses in patient safety disproportionately affect the oldest and sickest of patients, both in their incidence and in the severity of the consequences. Serious, long-term illness occurs mostly at the end of life-leading to more errors, adverse effects, and erratic and unsafe treatment patients in a population that is most in need of safe, reliable, coordinated care. Seriously ill patients are often subjected to a repeated series of mistakes, including: non-treatment of pain, delirium, and other symptoms; routine discontinuity within and among provider programs; location of care for provider convenience, rather than efficiency or family support; and a lack of focus on advance care planning. The Center aims to help improve the reliability of health care dramatically, by building capacity for improvement through effective change methods and knowledge about safe and correct care of individuals with chronic heart failure of chronic obstructive pulmonary disease. During Phase I, the Center will build a strong team, develop ties to health delivery systems, produce educational materials, and develop a proposal for at least one pilot study that it will carry out during Years 2 and 3. In Phase II, the Center will implement the pilot study(ies), present educational materials, and develop a dissemination for pilot study findings.