Determinants of treatment intensity for patients with serious illness: a new conceptual framework.

Journal of Palliative Medicine
Amy S KelleyCatherine A Sarkisian

Abstract

Research during the past few decades has greatly advanced our understanding of the cost, quality, and variability of medical care at the end of life. The current health-care policy debate has focused considerable attention on the unsustainable rate of spending and wide regional variation associated with medical treatments in the last year of life. New initiatives aim to standardize quality and reduce over-utilization at the end of life. We argue, however, that focusing exclusively on medical treatment at the end of life is not likely to lead to effective health-care policy reform or reduce costs. Specifically, end-of-life policy initiatives face the challenges of political feasibility, inaccurate prognostication, and gaps in the existing literature. With the ultimate aim of improving the quality and efficiency of care, we propose a research and policy agenda guided by a new conceptual framework of factors associated with treatment intensity for patients with serious and complicated medical illness. This model not only expands the population of interest to include all adults with serious illness, but also provides a blueprint for the thorough investigation of the diverse and interconnected determinants of treatment intensity. Th...Continue Reading

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Citations

Jan 25, 2013·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·Johannes BükkiChristoph Ostgathe
Mar 3, 2012·Journal of General Internal Medicine·Amy S KelleyCatherine A Sarkisian
May 3, 2012·Journal of General Internal Medicine·David A AlterPeter C Austin
Apr 4, 2014·Journal of Palliative Medicine·Amy S KelleyChristine S Ritchie
May 31, 2013·Journal of Palliative Medicine·Amy S Kelley
Nov 19, 2011·Journal of the American Geriatrics Society·Amy S KelleyCatherine A Sarkisian
Nov 8, 2014·Journal of the American Geriatrics Society·Evan C TschirhartAmy S Kelley
Mar 19, 2016·Journal of Palliative Medicine·Katherine A OrnsteinAmy S Kelley
Jul 24, 2014·Psycho-oncology·Reginald D Tucker-SeeleyHolly Prigerson
Jun 2, 2016·Journal of Palliative Medicine·Jay R HortonAmy S Kelley
Jun 7, 2016·Journal of Pain and Symptom Management·Yen-Ni HungSiew Tzuh Tang
Sep 3, 2016·Journal of the American Geriatrics Society·Elena ByhoffTheodore J Iwashyna
Sep 25, 2016·BMC Palliative Care·Xhyljeta LutaKerri Clough-Gorr
Jun 29, 2018·Health Services Research·Shi-Yi WangXiaomei Ma
Aug 5, 2017·Journal of Palliative Medicine·Amy S KelleyR Sean Morrison
Jun 14, 2016·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Katherine L MarcusRenee D Boss
Jun 9, 2020·The American Journal of Hospice & Palliative Care·Komal Patel MuraliAbraham A Brody
Aug 11, 2020·Seminars in Respiratory and Critical Care Medicine·Victoria Metaxa
Jun 24, 2019·Systematic Reviews·Victoria MetaxaRandall Curtis
Mar 1, 2018·Health Services Research·Katherine A OrnsteinAmy S Kelley
Jan 25, 2018·Journal of Palliative Care·Su Hyun KimMi-Kyung Song
Jan 20, 2019·Medical Care Research and Review : MCRR·Peter MayJ Brian Cassel
Jun 1, 2021·Surgical Oncology Clinics of North America·Alyssa K Ovaitt, Susan McCammon

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