End-of-Life Care in Nursing Homes: From Care Processes to Quality.
End-of-Life Care in Nursing Homes: From Care Processes to Quality.
复制标题
疗养院的临终关怀：从护理流程到质量。
DOI：
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复制
发表时间：
2016
影响因子：
2.8
通讯作者：
D. Mukamel
中科院分区：
文献类型：
--
作者：
H. Temkin;Qinghua Li;Yue Li;M. Segelman;D. Mukamel
背景/目标
疗养院 (NH) 是提供姑息治疗和临终关怀 (EOL) 的重要场所。过度依赖 EOL 住院治疗和临终关怀医院入组率低是这种情况下的关键质量问题。我们研究了 NH 提供者之间以及提供者与居民/家庭成员之间的沟通与两个 EOL 质量指标 (QM) 之间的关联：院内死亡和临终关怀服务的使用。
设计与方法
我们使用 2011-12 年在美国 NH 随机样本中实施的调查工具制定了两种沟通措施。使用二手数据（最小数据集、医疗保险和临终关怀索赔），我们针对院内死亡和临终关怀使用制定了两个经过风险调整的质量指标。在完成调查的 1201 个 NH 中，我们确定了 2011 年死亡的 54,526 名 65 岁以上居民。对两种沟通措施的心理测量评估包括主因素和内部一致性可靠性分析。估计随机效应逻辑和加权最小二乘回归模型，以开发设施级风险调整质量管理，并评估沟通措施对质量指标的影响。
结果
与居民/家庭成员更好的沟通在统计学上与院内死亡人数减少相关（p = 0.015）。然而，提供者之间更好的沟通与临终关怀的较低使用率显着相关（p = 0.006）。
结论
投资 NH 来改善提供者和居民/家庭之间的沟通可能会减少院内死亡。改善提供者之间的沟通似乎会减少而不是增加 NH 到临终关怀机构的转诊。需要更好地了解改善提供者沟通对居民 EOL 护理质量的实际影响。
BACKGROUND/OBJECTIVE
Nursing homes (NHs) are an important setting for the provision of palliative and end-of-life (EOL) care. Excessive reliance on hospitalizations at EOL and infrequent enrollment in hospice are key quality concerns in this setting. We examined the association between communication-among NH providers and between providers and residents/family members-and two EOL quality measures (QMs): in-hospital deaths and hospice use.
DESIGN AND METHODS
We developed two measures of communication by using a survey tool implemented in a random sample of U.S. NHs in 2011-12. Using secondary data (Minimum Data Set, Medicare, and hospice claims), we developed two risk-adjusted quality metrics for in-hospital death and hospice use. In the 1201 NHs, which completed the survey, we identified 54,526 residents, age 65+, who died in 2011. Psychometric assessment of the two communication measures included principal factor and internal consistency reliability analyses. Random-effect logistic and weighted least-square regression models were estimated to develop facility-level risk-adjusted QMs, and to assess the effect of communication measures on the quality metrics.
RESULTS
Better communication with residents/family members was statistically significantly (p = 0.015) associated with fewer in-hospital deaths. However, better communication among providers was significantly (p = 0.006) associated with lower use of hospice.
CONCLUSIONS
Investing in NHs to improve communication between providers and residents/family may lead to fewer in-hospital deaths. Improved communication between providers appears to reduce, rather than increase, NH-to-hospice referrals. The actual impact of improved provider communication on residents' EOL care quality needs to be better understood.
影响因子：
120.7
作者：
Teno, Joan M.;Gozalo, Pedro L.;Bynum, Julie P. W.;Leland, Natalie E.;Miller, Susan C.;Morden, Nancy E.;Scupp, Thomas;Goodman, David C.;Mor, Vincent
通讯作者：
Mor, Vincent
疗养院的临终关怀：CNA 员工沟通的重要性。
DOI：
10.1016/j.jamda.2010.01.006
发表时间：
2010
影响因子：
7.6
作者：
Zheng,NanTracy;Temkin-Greener,Helena
通讯作者：
Temkin-Greener,Helena