Family oversight and the quality of nursing home care for residents with advanced dementia.
Family oversight and the quality of nursing home care for residents with advanced dementia.
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DOI：
10.1097/mlr.0b013e318195fce7
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发表时间：
2009-05
期刊：
影响因子：
3
通讯作者：
Mitchell SL
中科院分区：
文献类型：
--
作者：
Grabowski DC;Mitchell SL
护理之家（NH）的质量照顾居民与晚期痴呆已被描述为次优。在提供国民健康保险方面，一个相对未被充分研究的因素是家庭成员和朋友的私人监督和监督的作用。研究私人监督与晚期痴呆症患者临终关怀质量之间的关系。本研究采用了323名居住在波士顿地区22家机构的晚期痴呆症NH居民的纵向数据。采用双变量和多变量方法，我们分析了居民健康护理代理（HCP）就诊时间与临终关怀质量指标之间的关系。访问时间与质量呈非线性关系。与没有就诊或每周就诊70小时的居民相比，每周就诊1-7小时的居民疼痛、压疮、呼吸困难和转院次数较少。在调整协变量后，与每周就诊1-7小时的居民相比，每周就诊7小时的居民有更多的压疮、更多的疼痛、更严重的呼吸困难、更少的DNH命令和更低的HCP满意度。对终末期痴呆的NH护理质量的几个衡量指标与HCP的监督程度呈非线性关系，例如，没有就诊或非常高的就诊水平与较差的质量相关。未来的研究将需要解决是否有更多监督的家庭倾向于做出更差的护理质量的决定，或者更差的护理质量是否促进了更大的家庭监督。
The quality of nursing home (NH) care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor in the provision of NH care is the role of private oversight and monitoring by family members and friends. To examine the association between private oversight and the quality of end-of-life care for NH residents with advanced dementia. This study employed longitudinal data on 323 NH residents with advanced dementia living in 22 Boston-area facilities. Using bivariate and multivariate methods, we analyzed the association between visit time by the resident’s health care proxy (HCP) and measures of quality of end-of-life care. The relationship between visit time and quality was nonlinear. Residents who were visited 1–7 hours/weekly had less pain, fewer pressure ulcers, less dyspnea and fewer hospital transfers compared to residents who had no visits or who were visited > 7 hours/week. After adjusting for covariates, residents who were visited >7 hour/week had more pressure ulcers, more pain, greater dyspnea, fewer DNH orders, and lower HCP satisfaction with care compared with residents who were visited 1–7 hours/week. Several measures of quality of NH care for end-stage dementia exhibit a nonlinear relationship with the degree of HCP oversight, such that no visiting or very high levels of visiting are associated with worse quality. Future research will need to address whether families with greater oversight tend to make decisions that promote worse quality of care, or whether worse quality of care promotes greater family oversight.