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Evidence to Practice
May 2015

Improving Quality of Care for Serious IllnessFindings and Recommendations of the Institute of Medicine Report on Dying in America

Author Affiliations
  • 1Department of Medicine, Duke Palliative Care, Duke University, Durham, North Carolina
JAMA Intern Med. 2015;175(5):840-841. doi:10.1001/jamainternmed.2014.8425

This review was conducted by the Institute of Medicine (IOM) and funded by an anonymous private donor. The IOM is a branch of the National Academy of Sciences and provides independent, objective, evidence-based advice to policy makers, health professionals, the private sector, and the public.

In 1997, in response to growing public awareness and a landmark study,1 the IOM issued a report entitled Approaching Death: Improving Care at the End of Life.2 This document, as well as a subsequent report dedicated to children,3 focused attention on the excessive and unnecessary suffering experienced by dying patients and helped to catalyze a movement for change.4 Impressively, many of the goals articulated in that report have been achieved, including the creation of palliative medicine specialty status, increased access to opioids for patients with pain, and the widespread adoption of hospital palliative care teams. And yet, both research and the everyday experience of patients, family members, and clinicians suggest that huge gaps remain in the quality of care for the most vulnerable patients. This poor care continues against a backdrop of rising health care costs and a sense that the patients who account for the greatest percentage of this expenditure do not benefit from, and may even be harmed by, its excess. Furthermore, policy reform efforts have been stymied by accusations of “death panels” and hijacked by a toxic health care political debate. In response, the IOM decided to assemble a diverse expert panel, review the progress since the prior report, and restart momentum toward improving care. On September 17, 2014, this IOM committee issued Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.5

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