Improving Care at the End of Life

Reviews RWJF's investments in improving end-of-life care, impact on the field, and lessons learned, including the need to coordinate objectives, integrate strategies, tie strategies to policy changes and incentives, and link communications and evaluation

Death is Certain; Strategy Isn't: Assessing the Robert Wood Johnson Foundation's End-of-Life Grantmaking

This report describes a strategic assessment of the Robert Wood Johnson Foundation's 20-year investment in end-of-life grantmaking. It illustrates the issues raised in conducting an assessment of a strategy rather than of a single program or initiative

Toward More Effective Use of Intermediaries: Discussion Guide

This study guide is designed to help you think through the concepts presented in Peter Szanton's monograph, Toward More Effective Use of Intermediaries, and consider how you might apply them in the everyday practice of philanthropy. The guide contains a series of exercises intended to stimulate individual reflection and serve as the basis for group discussion

Acts of Commission: Lessons from an Informal Study - Discussion Guide

This discussion guide is designed to help you think through the concepts presented in Janice Nittoli's paper, Acts of Commission: Lessons from an Informal Study, and consider how you might apply them in the everyday practice of philanthropy.The guide contains four exercises:The first exercise provides a role-play to explore the match between a commission strategy and foundation goals and mission.The second exercise presents a template to plan a commission's membership, and assure that it contains a balanced and diverse group of decisionmakers.The third exercise involves creating a "History of the Future" to identify the combination of elements that lead to a successful commission.The fourth exercise offers a series of questions to help a foundation staff person prepare to work with a media consultant to promote a commission's work.Following the exercises, a resource page contains Nittoli's checklist to help funders assess their readiness to launch a policy commission

Unmet need and psychological distress predict emergency department visits in community-dwelling elderly women: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Unmet need to perform activities of daily living (ADL) is associated with increased use of urgent health services by the elderly. However, the reported associations may be confounded by psychological distress. We examine the independent effects of unmet need and psychological distress upon emergency department (ED) visits.</p> <p>Methods</p> <p>We conducted a prospective study of randomly selected community-dwelling adults aged ≥ 75. We report here the results for women only (n = 530). In-person interviews collected data on self-reported unmet need and the 14-item <it>l'Indice de détresse psychologique de Santé Québec </it>psychological distress scale. ED visits were identified from an administrative database. Multivariable logistic regression was used to identify predictors of any ED visit in the 6 months following the baseline interview.</p> <p>Results</p> <p>In multivariable analysis, unmet need in instrumental ADL was associated with subsequent ED visits (odds ratio = 1.57, 95% confidence interval = 1.02-2.41), as was psychological distress (odds rate = 1.30, 95% confidence interval = 1.02-1.67). The magnitude of the association between unmet need and ED visits was overestimated in statistical models that did not adjust for psychological distress.</p> <p>Conclusions</p> <p>Both unmet need and psychological distress were independent predictors of ED visits. Future investigations of unmet need and health services utilization should include psychological distress to control for confounding and improve the internal validity of statistical models.</p

New Toolkit to Measure Quality of Person-Centered Care: Development and Pilot Evaluation With Nursing Home Communities

AbstractBackgroundIncreasingly, nursing home (NH) providers are adopting a person-centered care (PCC) philosophy; yet, they currently lack methods to measure their progress toward this goal. Few PCC tools meet criteria for ease of use and feasibility in NHs. The purpose of this article is to report on the development of the concept and measurement of preference congruence among NH residents (phase 1), its refinement into a set of quality indicators by Advancing Excellence in America's Nursing Homes (phase 2), and its pilot evaluation in a sample of 12 early adopting NHs prior to national rollout (phase 3). The recommended toolkit for providers to use to measure PCC consists of (1) interview materials for 16 personal care and activity preferences from Minimum Data Set 3.0, plus follow-up questions that ask residents how satisfied they are with fulfillment of important preferences; and (2) an easy to use Excel spreadsheet that calculates graphic displays of quality measures of preference congruence and care conference attendance for an individual, household or NH. Twelve NHs interviewed residents (N = 146) using the toolkit; 10 also completed a follow-up survey and 9 took part in an interview evaluating their experience.ResultsNH staff gave strong positive ratings to the toolkit. All would recommend it to other NHs. Staff reported that the toolkit helped them identify opportunities to improve PCC (100%), and found that the Excel tool was comprehensive (100%), easy to use (90%), and provided high quality information (100%). Providers anticipated using the toolkit to strengthen staff training as well as to enhance care planning, programming and quality improvement.ConclusionsThe no-cost PCC toolkit provides a new means to measure the quality of PCC delivery. As of February 2014, over 700 nursing homes have selected the Advancing Excellence in America's Nursing Homes PCC goal as a focus for quality improvement. The toolkit enables providers to incorporate quality improvement by moving beyond anecdote, and advancing more systematically toward honoring resident preferences