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April 24, 1996

The SUPPORT Project and Improving Care for Seriously III Patients-Reply

Author Affiliations

University of California, San Francisco

JAMA. 1996;275(16):1231. doi:10.1001/jama.1996.03530400015027

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In Reply.  —These letters illustrate the range of responses that the SUPPORT project has evoked and suggest the tasks that lie ahead if we are to improve the care of seriously ill patients. The groups led by Dr Frank and Dr Solomon argue that interventions that affect the entire health care organization can change physician behavior and institutional culture and practices. I agree with their analysis. The challenge is to demonstrate that organizational interventions in fact improve important clinical outcomes. SUPPORT has set a new standard for evaluating interventions that are intended to improve the care of dying patients. Factors other than the institution-wide intervention may influence outcomes. For instance, hospital lengths of stay may decrease for many reasons, such as financial incentives under managed care. End points must be selected carefully. In addition to improving hospital policies, institutions need to show that their interventions improve pain control, increase discussions