C-TAC Launches Initiative to Improve Advanced Illness Care

The Washington-based Coalition to Transform Advanced Care (C-TAC) is leading a new initiative to measure the quality of advanced illness care state-by-state and develop strategies for improvement. The first phase of the project will soon begin in Arizona in a project financed by the David and Lura Lovell Foundation. 

The Arizona program will use data on 37 measures gathered through C-TAC’s Advanced Care Transformation Index, a tool developed by C-TAC that examines 37 measures to assess the quality of advanced care in the United States. Also to support these efforts, C-TAC is currently creating a state-level index. 

Working with collaborating organizations the Arizona End-of-Life Care Partnership and the Arizona Hospital and Health Association, C-TAC will use the data to identify best practices from each state. 


“When you look at the states you start to see a story, and part of that story is that some states have increased their capacity to care for patients with advanced illness and others have not. We are asking why those states grew those care patterns better than others,” Lou Gagliano, strategic advisor for C-TAC, told Hospice News. “In many states patients and families do not have adequate choices when it came to their serious illness or end-of-life care; meanwhile demand is growing faster than supply, and the consequences to the Medicare and Medicaid systems are going to be even more impactful in terms of the amount of money allocated to that sector.” 

More than 17 percent of Arizonans are age 65 or older, according to the U.S. Census Bureau. Arizona has the second highest rate of hospice utilization among U.S. states, with 59.2% of Medicare-enrolled decedents dying in hospice, according to the National Hospice & Palliative Care Organization, trailing only Utah at 59.4%.

As the baby-boomer generation continues to age, a rising number of older adults will experience advanced illnesses, when one or more chronic conditions progress to the point where general health and functioning declines and response to treatment is reduced.


C-TAC’s national index initially collected data on about a dozen measures, a number that has grown to 37. Examples include the number of patients who die in their homes, those who have advanced care plans, the number of home health agency visits in the state, hospice utilization, and patient days in an intensive care unit, among others.

Only 29.4% of people in the United States die in their homes according to C-TAC, even though the Kaiser Family Foundation reports that 7 in 10 would prefer to pass away at home.

“Putting people and patients first is a key value of our Partnership,” explains Sarah Ascher, senior director of the Arizona End-of-Life Care Partnership. “This project will enable us to learn more about the experiences of those with advanced illness and promote person-centered care across the state.” 

The next steps for the partner organizations is to form a steering committee that includes representatives of community-based health care organizations as well as payers and state government officials, among other stakeholders. The committee will analyze the data to identify opportunities for improvement, select best practices to adapt from other states and create a work plan to implement those practices. 

“We need to identify not only what the issues are but how to implement solutions. The best laid plans of mice and men die because implementation never occurs,” Gagliano told Hospice News. “I believe the work we are doing will move care away from institutional settings back into the community, and we will increase not only the choices available to families but help improve the quality and economic trends in advanced illness care throughout the United States.” 

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