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April 24, 1996

The SUPPORT Project and Improving Care for Seriously III Patients

Author Affiliations

Wayne State University School of Medicine
Detroit Receiving Hospital Detroit, Mich

JAMA. 1996;275(16):1228-1229. doi:10.1001/jama.1996.03530400015021

To the Editor.  —Although we agree with the conclusions of the SUPPORT project1 that substantial shortcomings exist in care for seriously ill hospitalized patients, specifically regarding end-of-life decision making, and that the "phase II" interventions failed to improve care or patient outcomes, we are not surprised. We agree that greater individual and societal commitment as well as more practical and forceful measures are needed.We have a combined experience in an acute care hospital with a nurse-physician partnership for end-of-life care that we call the Comprehensive Supportive Care Team (CSCT).2 Our experience with this subspecialty practice in affecting the way physicians care for dying patients is quite different from that reported by the SUPPORT investigators. Our data show reductions in ICU and hospital lengths of stay for dying patients with a corresponding reduction in hospital charges and use of resources through appropriate care planning with consideration of the