Improving Health Care and Palliative Care for Advanced and Serious Illness: 8. Closing the Quality Gap: Revisiting the State of the Science Executive Summary. Evidence Report/Technology Assessment Number 208.

摘要

Although extensive evidence supports the effectiveness of clinical interventions for improving palliative care for patients with advanced and serious illness, many studies have found that these interventions are often not used sufficiently in practice.1,2 As part of a larger review of interventions aimed at reducing the quality gap (the difference between health care processes or outcomes observed in practice and evidence-based practices potentially obtainable on the basis of current professional knowledge), we conducted a review focusing on interventions to improve care and outcomes in patients with advanced and serious illness. We defined the included population as seriously ill patients and those with advanced disease (such as people living with advanced cancer or intensive care unit patients at high risk of dying) who are unlikely to be cured, recover, or stabilize.3,4 We classified interventions to improve care for this population by the framework shown in Figure A.5 The framework shows the literature in palliative care as a grid, with different populations, domains of care, targets of quality improvement, settings (and integrated care), conditions, and categories of relevant interventions. The targets show the areas where an intervention might focus-such as an intervention specifically targeting pain management in patients with advanced disease. Areas that were the focus of this review are underlined in the figure.