IHI’s Care at the End of Life Accelerator

Q&A with David Hoffman

David N. Hoffman is a clinical ethicist, healthcare attorney, and Senior Advisor to the Completed Life Initiative. Below, he speaks about his recent collaboration with the Institute for Healthcare Improvement (IHI) to develop a Care at the End of Life Accelerator.

graphic of logos for Institute for Healthcare Improvement and Completed Life Initiative

The Institute for Healthcare Improvement (IHI) has a Care at the End of Life Accelerator. What exactly is this?

This accelerator is a project that I started in October 2024 to establish a new standard for delivering a complete continuum of end-of-life care. Patients approaching the end of their lives often undergo many care transitions, such as going from a curative treatment plan to a palliative treatment plan, or going from a nursing home to a hospice. The purpose of the accelerator is to define a legally enforceable responsibility on the part of clinicians and institutions to facilitate a warm transition for a patient from one mode of care to the next. This warm handoff is intended to ensure that patients are transferred from one mode of care to another properly and that the care providers who receive the patient are prepared to offer treatment (or support the patient’s choice to withhold treatment) that is consistent with the patient’s expressed values and preferences.

How would a program like this work, and what could its potential impact be?

Our multidisciplinary team conceptualized and executed a transition-of-care decision support tool that enables the individuals responsible for navigating the patient’s care transition at a referring institution to engage with all necessary patient information for a successful transition. By having access to the necessary patient information, including the patient’s medical record, care teams can affirmatively engage with the proposed receiving healthcare institution or care provider to ensure that they are willing and able to assume responsibility for the patient’s next mode of care that is respectful of the patient’s choices and priorities. Additionally, the program details that the care providers must be willing to offer transfer to the next appropriate mode of care when the time comes.

How would this program help those interested in learning more about medical aid in dying (MAID)?

One of the purposes of the accelerator is to ensure that people who are considering medical aid in dying and other forms of ending life care, including voluntarily stopping eating and drinking (VSED) and palliative sedation in all its forms, are not admitted to a facility that fails to implement or adequately facilitate their prescribed care plan. Sometimes such organizations will promise to honor a patient’s expressed wishes without regard to the actual willingness of the organization to implement particular modes of ending life care that the patient may want available, as options as the patient’s condition and needs change.

Would this IHI Accelerator just be offered in states and jurisdictions where MAID is legal?

Currently, the standard we’ve created for patient transfer is designed to ensure continued access and support to medical aid in dying in jurisdictions where it is legally available. However, the standard can and should be implemented in all jurisdictions so that care providers at each stage of a patient’s journey are aware that, in order to fulfill the patient’s rights and expectations, transfer from a non-MAID state to a legalized MAID state may be part of their future responsibility to their patient.

How successful have similar IHI accelerator programs been in the past?

IHI hosts accelerator projects on a wide variety of quality of care initiatives designed to ensure that patients receive all of the care that they need in respect to the patient’s choices and priorities. These initiatives have included efforts to promote access to care through health equity projects and to ensure that technological advances, such as artificial intelligence-enabled decision support and decision substitution tools, work to provide each patient with the best possible outcome when using the healthcare delivery system.