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March 2013

A Call to Action: Improving Value by Emphasizing Patient-Centered Care at the End of Life

Author Affiliations

Author Affiliations: Departments of Urology (Drs Bergman and Litwin), and Health Services, and Jonsson Comprehensive Cancer Center (Dr Litwin), University of California, Los Angeles; VA Greater Los Angeles Healthcare System and University of California at Los Angeles/Robert Wood Johnson Clinical Scholars Program (Dr Bergman), Los Angeles; and RAND Corporation, Santa Monica (Dr Brook), California.

JAMA Surg. 2013;148(3):215-216. doi:10.1001/jamasurg.2013.1568

Medical care during life's final stages is often poorly coordinated and inattentive to patient preferences, typically owing to a failure to ascertain each individual's goals. End-of-life care also consumes substantial health care dollars. For example, 30% of Medicare resources are expended on the 5% of beneficiaries who die each year,1 and one-third of costs in life's last year is accounted for in life's last month.2 Research indicates that physicians and health care professionals can do better. Studies have all shown improvement in clinical care by assessing end-of-life preferences,3 delivering value-congruent care,4 and coordinating the care recommended by different health care providers (ie, primary care practitioners, oncologists, surgeons, and palliative care clinicians who are specialized in addressing supportive needs as death approaches).5

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