Serious and complex illness in quality improvement and policy reform for end-of-life care

Americans are living longer - a mark of success in public health and medical 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 this population are mismatched in this model, Here, we propose a more useful category for public policy and clinical quality improvement: persons who will die as a result of serious and complex illness. Delivery system changes could ensure reliable, continuous, and competent care to this population.