State Variability in Assisted Living Residents' End-of-Life Care Trajectories.
State Variability in Assisted Living Residents' End-of-Life Care Trajectories.
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DOI：
10.1016/j.jamda.2019.09.013
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发表时间：
2020-03
影响因子：
7.6
通讯作者：
Carder, Paula
中科院分区：
文献类型：
--
作者：
Thomas, Kali S.;Belanger, Emmanuelle;Zhang, Wenhan;Carder, Paula
越来越多和越来越脆弱的人口居住在辅助生活中。各州负责管理辅助生活，但各国的要求各不相同。关于这种变异性如何转化为受助生活居民临终经历的差异，人们知之甚少。这项研究的目的是描述受助生活居民的临终关怀轨迹，以及它们如何因州而异。观察性回溯性队列研究使用联邦医疗保险数据和开发的方法来确定居住在大型辅助生活社区(25张以上床位)的受益人，我们确定了美国大陆40,359名参加传统医疗保险并于2016年死亡的辅助生活居民。我们使用联邦医疗保险数据和住宅历史档案来检查辅助生活居民在生命最后30天内接受护理和服务的地点。在全国范围内，我们的队列中57%的人死于医院或疗养院以外(n=23,165)，其中18,396人在死亡时接受了临终关怀。在生命的最后30天里，住院率和转到养老院的比率都有所上升。我们观察到死亡前一个月在辅助生活中的调整天数存在显著的州际差异(从北达科他州的13.6天(95%CI：11.8，15.4)到犹他州的24.0天(95%CI：22.7，25.2))，以及在生命最后一个月接受临终关怀的调整天数的更大差异，从北达科他州的2.1天(95%CI：1.0，3.2)到犹他州的13.8天(95%CI：12.1，15.5)。研究结果表明，受助生活居民的死亡轨迹因州而异。为了确保辅助生活居民的最佳临终结果，国家政策制定者应考虑其法规如何影响辅助生活的临终关怀，未来的研究应审查可能使辅助生活居民就地死亡并有助于区别获得临终关怀服务的因素(例如，国家法规、市场特征、提供者特征)。这项使用2016年联邦医疗保险索赔数据的回溯性观察研究表明，受助居住居民的死亡地点和在生命最后一个月接受的服务因州而异。
A growing and increasingly vulnerable population resides in assisted living. States are responsible for regulating assisted living and vary in their requirements. Little is known about how this variability translates to differences in the dying experiences of assisted living residents. The objective of this study is to describe assisted living residents’ end-of-life care trajectories and how they vary by state. Observational retrospective cohort study Using Medicare data and a methodology developed to identify beneficiaries residing in large assisted living communities (25+ beds), we identified a cohort of 40,359 assisted living residents in the continental US enrolled in traditional Medicare and who died in 2016. We used Medicare data and the Residential History File to examine assisted living residents’ location of care and services received in the last 30 days of life. Nationally, 57% of our cohort died outside of an institutional setting, i.e., hospital or nursing home, (n=23,165), 18,396 of whom received hospice at the time of death. Rates of hospitalization and transition to a nursing home increased over the last 30 days of life. We observed significant inter-state variability in the adjusted number of days spent in assisted living in the month before death (from 13.6 days (95% CI: 11.8, 15.4) in North Dakota to 24.0 days (95% CI: 22.7, 25.2) in Utah) and wider variation in the adjusted number of days receiving hospice in the last month of life, ranging from 2.1 days (95% CI: 1.0, 3.2) in North Dakota to 13.8 days (95% CI: 12.1, 15.5) in Utah. Findings suggest that assisted living residents’ dying trajectories vary significantly by state. To ensure optimal end-of-life outcomes for assisted living residents, state policymakers should consider how their regulations influence end of life care in assisted living, and future research should examine factors (e.g., state regulations, market characteristics, provider characteristics) that may enable assisted living residents to die in place and contribute to differential access to hospice services. This retrospective observational study using 2016 Medicare claims data suggests that assisted living residents’ places of death and services received in the last month of life vary significantly by state.
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影响因子：
2.1
作者：
Bradford A;Kunik ME;Schulz P;Williams SP;Singh H
通讯作者：
Singh H
影响因子：
7.7
作者：
Russ, Tom C.;Batty, G. David;Starr, John M.
通讯作者：
Starr, John M.
影响因子：
2.8
作者：
Dobbs, Debra Jean;Hanson, Laura;Munn, Jean
通讯作者：
Munn, Jean
DOI：
10.1001/jama.2018.8981
发表时间：
2018-07-17
期刊：
JAMA
影响因子：
--
作者：
Teno JM;Gozalo P;Trivedi AN;Bunker J;Lima J;Ogarek J;Mor V
通讯作者：
Mor V
DOI：
10.1046/j.1532-5415.2003.51186.x
发表时间：
2003-04-01
影响因子：
6.3
作者：
Coleman, EA;Boult, C
通讯作者：
Boult, C