Patients Identify ACP Barriers

Tracking the Care of Patients with Severe Chronic Illness

I guess it shouldn't surprise me, but when I looked at the information in the April, 2008 Dartmouth Atlas of Health Care, I was taken aback. The Atlas looked at the outcomes of chronic disease care and tracked these outcomes against the resources attached to them. It was found that when it comes to getting care for a chronic disease, geography matters. Depending on where they live and what hospital or health care organization they use, these patients receive very different care.
These variations in care appear not to be linked to how sick the patients are, and, it turns out that the places where more resources are available are not the places demonstrating better care and better health outcomes.
This article focuses on supply sensitive care for patients with severe chronic illness in the last 2 years of their life. Areas that had offered more resources actually had a slightly higher mortality rate (over a period of up to 5 years) for patients following acute myocardial infarction, hip fracture, and colorectal cancer diagnosis--with no difference in functional status. As well, in higher-resourced settings, patients reported worse access to care and greater waiting times, with no difference in patient-reported satisfaction with care.
Paul Batalden's quote is so appropriate: "Every system is perfectly designed to get the results it gets."

What Would Happen if We Actually Listened to Each Other?

What Matters Most in End-of-Life Care: Perceptions of Seriously Ill Patients and Their Family Members.

The Go-to Person for Legal Advice

Joan Rush is an expert in the legal field and a savvy researcher. She understands Advance Care Planning at so many levels. In her law practice, she consults in the areas of health law, corporate governance, insurance law, and legal issues relevant to health care providers and the financial services industry. Prior to establishing her consulting practice, Joan was Vice President and General Counsel of a Canadian life insurance company.
Joan is a member of the Board of Directors for Community Living B.C., and a former adjunct Professor at the Faculty of Law, University of British Columbia. Joan completed her LL.M. thesis in the area of health law and ethics in 2005 and received her Master of Laws degree from UBC in 2006. Her thesis focused on advance directives and the law.
Her comprehensive overview of the state of advance directives in Canada, was first published in the Canadian Journal of Medical Radiation Technology (now the Journal of Medical Imaging and Radiation Sciences ). Visit www.jmirs.org to access current and past issues of JMIRS, and coming soon, CJMRT.

Draw Me a Response

This great diagram is found in the article by Joanne Lynn and Nathan Goldstein (Advance Care Planning for Fatal Chronic Illness: Avoiding Commonplace Errors and Unwarranted Suffering) published in the May 20, 2003 Annals of Internal Medicine.
It captures the essential elements of ACP for individuals with eventually fatal chronic disease.

Cartoons; A Great Way to Get the Message Out

Check Out These CJMRT Articles

This article was first published in the Canadian Journal of Medical Radiation Technology (now the Journal of Medical Imaging and Radiation Sciences ). Visit www.jmirs.org to access current and past issues of JMIRS, and coming soon, CJMRT.