Joanne Lynn is Director of The Washington Home Center for Palliative Care Studies, Senior Scientist at the RAND Corporation, and President of Americans for Better Care of the Dying. She is the coauthor of Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians (2000) and Handbook for Mortals: Guidance for People Facing Serious Illness (1999), among other books. She has coedited several books, including A Good Dying: Shaping Health Care for the Last Months of Life (1998) and By No Extraordinary Means: The Choice to Forgo Life-Sustaining Food and Water (1986). She has also been a physician serving people living out the end of life in hospices, nursing homes, home care, and hospitals.

• List of Illustrations and Tables Foreword Acknowledgments Introduction 1. JUST THE FACTS Serious Chronic Disease in the Last Phase of Life Living with Chronic Conditions . Shortcomings in Current Care .The Baby Boom Grows Old . Who Will Provide Care? . “Dying” andthe Problem of Prognostication . Which Illness Will It Be? .Costs and Who Pays . The Shape of Things to ComePERSPECTIVE: THE LONELINESS OF THE LONG TERM CARE GIVER by Carol Levine 2. SEEING THE WORLD DIFFERENTLYIdeas to Shape Reform Life Span Perspective . Rethinking the Transition Model .Misleading Words and Ideas . The “No Surprise” Question . Trajectories ofIllness across Time . Frequency of Trajectories . Anticipating Challenges .Creating and Naming a Category . More Patients, Fewer Caregivers .WorkingOut Patterns of Cost . Summary of Ideas to Shape ReformPERSPECTIVE : QUALITY COMES HOME by Donald M. Berwick 3. GOOD CARE FOR SOME PEOPLE SOMETIMES Hospice . Palliative Care at Home . Palliative Care in Hospitals . PACE:All-Inclusive Care . The Chronic-Care Model . Coordinating andManaging Care . Quality Improvement . Caregiver Programs . PracticeGuidelines and Audit Tools . Gems and Strategies for ChangePERSPECTIVE IN BRITAIN, PROGRESS IN CARE FOR THE LAST PART OF LIFE by Joanne Lynn 4. SURVERYING THE TERRAIN Opportunities and ChallengesKey Features of Change . Caregivers as a Political Force . The BusinessCase for Change . Promoting Coordinated Care . Barriersto Reform . Avoiding Low-Impact ReformsPERSPECTIVE: THE CASE FOR REFORMING U.S. HEALTH CAREby the Committee on Quality of Health Care in America, Institute of Medicine 5. GOOD CARE FOR US ALLBuilding the Care System to Count On Reprise of the Current Situation . Trajectories Form a Basis for AchievableExcellence . MediCaring: From Promises to Practical Program . Methods toAchieve Reform . Reforms to Implement Right Away! . Forging theWill to Make Improvements HappenAppendix: An Agenda for Action References Index

"Joanne Lynn is a national treasure - the most articulate, courageous, and scientifically-grounded voice in our nation for the improvement of health care for people approaching the end of life. For the public and professionals alike, her work provides motivation and sound guidance for building the care system we need, a system that we do not yet, by any means, have." - Donald M. Berwick, M.D., M.P.P., President and CEO, The Institute for Healthcare Improvement"