Project Categories

First the ICU, then Hospice

Award Year: 2013 Investigator: Joan Teno
In 1982, Senator John Heinz introduced an amendment as part of the Tax Equity and Fiscal Responsibility Act that added hospice coverage to Medicare beneficiaries. Innovations in Medicare usually focus on payment, not on creating a new benefit. This amendment defined a new benefit with the goal of being cost neutral or reducing the cost of end of life care. Hospice is now part of mainstream medicine and hospital based palliative care teams are part of 80% of hospitals with more than 300 beds.

Gatekeepers at Life's End: Surrogate Decision Making in Intensive Care

Award Year: 2011 Investigator: Susan Shapiro
The end of life epitomizes a public health priority: "high burden, major impact, and a potential for preventing the suffering associated with illness." Less apparent, life's end for a majority of Americans is in the hands of others, gatekeepers who control their end-of-life medical care. Until now, the process by which treatment decisions were considered, made, and remade for those who lack decisional capacity had eluded rigorous empirical examination.

Regional Variations in End of Life Care and Costs: Cultures of Medicine or Structures of Caregiving?

Award Year: 2011 Investigator: Carla Keirns
Americans facing serious illness receive different care, at different costs, and with different outcomes based on where they live.

Race, Racism, and American Medicine

Award Year: 1999 Investigator: Vanessa Northington Gamble
Dr. Gamble examines the relationship of African Americans to the U.S. medical system in the twentieth century.