"Serious and complex illness" in quality improvement and policy reform forend-of-life care

Americans are living longer - a mark of success in public health and medica l care - but more will live the last few years with progressive illness and disability. The dominant conception of care delivery separates "aggressive " or life-extending care from "palliative" or death-accepting care, with an assumed "transition" between them. The physiology and the experience of th is population are mismatched in this model, Here, we propose a more useful category for public policy and clinical quality improvement: persons who wi ll die as a result of "serious and complex illness." Delivery system change s could ensure reliable, continuous, and competent care to this population.