The 2015 Institute of Medicine Report: Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life noted that while hospice care has now become mainstream, there are still gaps in care at the end of life.  Many individuals are not engaged in thinking about and expressing their preferences for end of life care.  Further, systems established for curative care are not well integrated with palliative and hospice care.  The IOM concluded that improvements in quality of care at end of life are attainable.  Improving the care continuum could improve quality of life for patients, reduce the use of unwanted services, and improve the experience of patients and families. 

In Spring, 2016 VNAA convened a work group of members representing home health, hospice and palliative care to discuss strategies for improving the continuum of care at the end of life.  The group focused specifically on what home-based care organizations can do to educate and engage people, promote development of programs, and align services to offer a continuum of care for patients needing acute, palliative, or hospice care.  Barriers to improved end of life care include lack of reimbursement for services across the continuum, lack of patient information, and difficult handoffs from acute to palliative to hospice care. This module focuses on reducing barriers and developing the environment for an improved continuum of care for patients.  The VNAA Blueprint for Excellence End of Life module offers best practice recommendations for patient-specific interventions by home-based care practitioners. 

The VNAA Hospice Best Practice Work Group identified multiple innovative approaches for home-based care organizations to interface with patients, communities, and other health care providers to improve the continuum of care. This module captures their best practice recommendations in the Tools and Interventions section, identifies Resources and References, discusses approaches to Performance Measurement and Evaluation, and links to free Training opportunities. Through these Best Practice strategies, VNAA hopes to support home-based care organizations in replicating innovative approaches. 

The VNAA Improving the Continuum of Care module was developed and/or reviewed by the Hospice Best Practice. It reflects both available evidence and the expert recommendations of industry leaders participating on VNAA's Best Practice Work Group. We encourage users to visit other sections of the VNAA Blueprint for Excellence to drill down on related issues.