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Predictors of reliably high-value end-of-life care

Ankuda, Claire K.a; Meier, Diane E.a,b

Current Opinion in Supportive and Palliative Care: December 2018 - Volume 12 - Issue 4 - p 460–465
doi: 10.1097/SPC.0000000000000392
END OF LIFE MANAGEMENT: Edited by Gustavo De Simone and Bridget Johnston

Purpose of review Care near the end of life is expensive and frequently not aligned with the expressed preferences of decedents, creating an opportunity to improve value, or increase quality while lowering cost. This review examines publications from 2017 and 2018 on interventions and policies associated with high-value end-of-life care. Innovations in video and web-based advance care planning are promising to improve preference-congruent care at low cost.

Recent findings The patterns of care within hospice and in particular increased investment in patient care in hospice are shown to improve value. A meta-analysis demonstrated the role of inpatient palliative care consultations in decreasing hospitalization costs, as did several studies on inpatient palliative care units. Internationally, a range of home-based palliative care programs, implemented at the population level, demonstrated cost savings and reduced intensive care near the end of life. Finally, public policies that funded medical and long-term care and address broader inequalities were demonstrated to decrease low-value care near the end of life.

Summary This review demonstrates the efficacy of a range of approaches to improve value of care at the end of life, both within the health system and across public policy sectors.

aBrookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai

bThe Center to Advance Palliative Care, New York, New York, USA

Correspondence to Claire K. Ankuda, MD, MPH, Department of Geriatrics and Palliative Medicine, One Gustave L. Levy Place, Box 1070, New York, NY 10029, USA. Tel: +1 212 241 0635; e-mail:

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