Page 76 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Plenary Sessions

P1.1 Putting Our Patient at the Centre 10:45 Convention Hall

Tuesday, 3 May Delivering End-of-life Care in Non-palliative Care Settings
Currow DC
Flinders University, Australia

Although enormous focus has been brought to the end-of-life disease trajectory of people with cancer, a much greater burden
is seen across the community: end-stage organ failure, neurodegenerative diseases, and AIDS and other communicable
diseases.

Each of these clusters has a disease trajectory which helps to dictate the needs of patients and their caregivers as people
face the end-of-life. For us to focus on the health of whole communities, health services and policy makers must embrace the
proactive care of everyone facing an “expected” death.

For end-stage organ failure, this has been described in the literature as a typical “sawtooth” trajectory with acute
exacerbations from time to time within the context of an overall deterioration. Each of these exacerbations may, itself, lead to
death.

For neurodegenerative diseases, motor neurone disease and multiple sclerosis are well characterised. By far the biggest
burden across our community is dementia. The rates of dementia are going to increase dramatically in the decades ahead as
the health of the community improves and other reasons for death become less frequent.

Communicable diseases still form a major cause of expected death across much of the community. Acute infections aside,
advanced AIDS, viral hepatidities and malaria continue to exact a massive burden on people internationally.

Ultimately, a needs-based approach to end-of-life care dictates that people, irrespective of diagnosis and prognosis, need to
be able to access care. Such care includes supporting caregivers who, around the world, continue to provide the bulk of care
in the last months of life.

A compassionate and caring community can be judged by the care that it provides to the most marginalised people. Ensuring
that we provide care for the voiceless is the most practical demonstration that community cares for the wellbeing of everyone.

P1.2 Putting Our Patient at the Centre 10:45 Convention Hall

Eradicating an Economic Tapeworm
Milstein A
Clinical Excellence Research Centre, Stanford University, USA

There are three primary strategies for lowering the cost of high quality health care — commonly referred to as improving “value’.
The presenter will review each strategy, the required pace of healthcare value improvement in advanced economies, and
scalable features of American primary care teams that currently manage the health of populations at the nation’s high-value
frontier.

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