A legislatively authorized, permanent council serves as an effective catalyst for concrete, sustained progress on high-priority policy issues related to end-of-life care in Maryland.
Care coordinators in a large integrated system engage in culturally tailored discussions with low-income seniors about completing advance directives, leading to higher completion rates and a narrowing of the gap in completion rates between African Americans/black immigrants and whites.
The Advanced Illness Management program supports Medicare patients with advanced illness and their families in making patient-centered decisions, leading to greater use of hospice care, lower inpatient and ambulatory utilization and overall care costs, and high levels of patient, family, and physician satisfaction.
Working as part of an “intensive care unit without walls,” critical care physicians (called intensivists) decide which patients require intensive care unit admission and oversee the care of all critically ill patients throughout the hospital, leading to declines in hospital and intensive care unit mortality, improved management of intensive care unit bed capacity, and low intensive care unit length of stay for terminally ill patients.
A transitional care program that identifies frail elderly patients in the hospital and provides them with in-home support after discharge significantly reduces readmissions and emergency department visits.
Trained peer mentors guide individuals with mental illness through lectures and interactive exercises that increase their knowledge and ability to manage their illness, making them feel more confident and more connected with others.
Counseling and care coordination for patients with advanced illnesses improved patient–provider communication and the quality of medical care and decisionmaking support, leading to more patients completing advance directives and lower inpatient care requirements.
Standardized, community-wide education, trained facilitators, and improved management processes lead to more advance care planning by patients, high levels of consistency between such plans and actual end-of-life decisions, and low care costs in the last 2 years of life.
Providence Hospital's culturally sensitive palliative care service ensures appropriate medical and pain management, provides emotional support, and dispenses accurate information about palliative care to help the hospital's largely African-American population cope with end-of-life issues.