Nursing home physician educational intervention improves end-of-life outcomes.
Nursing home physician educational intervention improves end-of-life outcomes.
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DOI：
10.1089/109662103764978452
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发表时间：
2003-04-01
影响因子：
2.8
通讯作者：
Eger, Ruth E
中科院分区：
文献类型：
--
作者：
Keay, Timothy J;Alexander, Carla;Eger, Ruth E
背景：在美国，疗养院是五个死亡病例中的一个。不幸的是，这些死亡往往伴随着疼痛和不适的症状。目的：为了确定是否为护理之家医生设计的教育干预提高了护理之家居民的死亡质量。设计：前瞻性测量临终医疗护理指标的变化。干预：半天的成人教育外展计划，包括审计和反馈，针对意见领袖，和质量改进建议。五个地理位置不同的马里兰州熟练的护理设施，共654 beds.Participants：终端护理提供的61名医生谁照顾203垂死的居民在5个设施进行了审查。干预措施的对象是医疗主任和那些拥有大多数病人的医生。12名医生参加了教育计划。主要结果测量：图表文件的认识可能的死亡，存在的预先指示，疼痛控制，镇痛药的使用，呼吸困难控制，控制不舒服的症状在死亡过程中，记录卫生，记录丧亲支持，和总的病人舒适度。完成干预的四家护理机构在临终关怀结局方面都有显着改善（p < 0.001，卡方检验）。在没有完成干预的队列护理机构中，任何指标都没有发现统计学显著变化。当我们比较居民与临终关怀服务，那些没有，我们发现显着增加的文件更好的卫生，丧亲支持，和总的病人舒适度（p < 0.001，卡方为每个）。结论：重要的终端护理结果可以显着提高针对重点护理之家医生与成人教育计划，包括审计和反馈，质量改进建议。
CONTEXT: Nursing homes are the setting for one of five deaths in the United States. Unfortunately these deaths are often accompanied by pain and symptoms of discomfort.OBJECTIVE: To determine if an educational intervention designed for nursing home physicians improves the quality of dying for nursing home residents.DESIGN: Prospective measurement of changes in end-of-life medical care indicators.INTERVENTION: Half-day adult educational outreach program, including audit and feedback, targeted at opinion leaders, and quality improvement suggestions.SETTING: Five geographically diverse Maryland skilled nursing facilities with a total of 654 beds.PARTICIPANTS: The terminal care delivered by 61 physicians who cared for 203 dying residents in the 5 facilities was reviewed. An intervention was targeted to medical directors and those physicians with the majority of patients. Twelve physicians participated in the educational program.MAIN OUTCOME MEASURES: Chart documentation of recognition of possible death, presence of advance directives, pain control, analgesics used, dyspnea control, control of uncomfortable symptoms during the dying process, documented hygiene, documented bereavement support, and total patient comfort.RESULTS: The four nursing facilities that completed the intervention all had significant improvements in end-of-life care outcomes (p < 0.001, chi2). No statistically significant changes were found in any measure in the cohort nursing facility that did not complete the intervention. When we compared residents with hospice services to those without, we found significant increases in documentation of better hygiene, bereavement support, and total patient comfort (p < 0.001, chi2 for each).CONCLUSIONS: Important terminal care outcomes can be significantly improved by targeting key nursing home physicians with an adult educational program that includes audit and feedback, and quality improvement suggestions.