Volume XXVll, No. 6
September 2013
The Independent Medical Business Newspaper
End-of-life decisions Technology and advance care planning By Jeffrey B. Rubins, MD, and Tomás Valdivia, MD
U
H
ealth care delivery and the educational systems that produced its providers and managers diverged during the managed care era of the 1980s
PAID
By Frank Cerra, MD
and early 1990s, with the care delivery models moving in a different direction from the way providers were educated and trained. Physician education and training continued in the Flexner model, with its physician-centric process of care and more emphasis on medical science and research than on the service and Shaping our future to page 10
PRSRT STD U.S. POSTAGE
Reconnecting physician education and clinical practice
End-of-life decisions to page 12
Detriot Lakes, MN Permit No. 2655
Shaping our future
nderstanding and enacting people’s values and preferences regarding medical care for life-limiting disease are tantamount to achieving the Institute for Healthcare Improvement’s triple aim of improved quality of care, improved experience for patients and families, and reduced unnecessary health care expenditures. Yet, despite efforts over the past decades to realize these goals, only a minority of adults have considered and indicated their wishes for end-of-life care. Less than 20 percent of adults have completed advance directives or have documented discussions about end-of-life care, and only 44 percent of people have communicated their end-of-life wishes to family members. Even when patients’ wishes are known, they are not reliably enacted when patients are hospitalized. As reported by the Agency for Healthcare Research and Quality in 2003, only 30 percent of physicians whose patients had an advance directive were aware that it existed, and in only 50 percent of cases where an advance directive existed was it used for end-of-life decisions. Not surprisingly, nearly 30 percent of all Medicare spending is for treatment during the last year of life, representing more than