Nursing Home Residents With Dementia: Association Between Place of Death and Patient Safety Culture.
Nursing Home Residents With Dementia: Association Between Place of Death and Patient Safety Culture.
复制标题
患有痴呆症的疗养院居民：死亡地点与患者安全文化之间的关联。
DOI：
10.1093/geront/gnaa188
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Temkin-Greener,Helena
中科院分区：
文献类型：
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作者：
Orth,Jessica;Li,Yue;Simning,Adam;Zimmerman,Sheryl;Temkin-Greener,Helena
背景和目的疗养院（NHs）照顾70%的美国人死于痴呆症。许多人认为，对这些居民中的大多数人来说，在NHS而不是医院死亡是更可取的。NH的特点，如工作人员的团队合作，沟通，和病人安全文化（PSC）的其他组成部分，加上国家最低NH护士人员配置要求，可能会影响死亡的位置。我们研究了这些变量和死亡地点（NH/医院）之间的关联在居民与demential.Research Design和MethodsCross-sectional研究11，957长期居住NH居民与痴呆症，年龄65岁以上，谁死在NH或医院出院后不久，从800个美国NHs之一2017。多变量逻辑回归系统地估计PSC对痴呆患者住院死亡几率的影响，控制居民，NH，县和州的特征。Logistic回归还确定了调节作用的国家最低NH护士的人员配置要求之间的关系关键PSC域和位置的death.ResultsResidents与痴呆症在NHs与较高的PSC分数在沟通开放度有较低的几率在医院死亡。这种影响是更强的NH位于国家与更高的最低NH护士人员配置requirements.Discussion and ImplicationsPromoting沟通开放性在NH跨护理学科可能有助于避免不必要的住院治疗在生命的尽头，值得特别注意的NH地址护理人员的组合，同时坚持国家的人员配置要求。未来的研究，以更好地了解意外后果的人员配置要求是必要的，以改善临终关怀在NHS。
Background and ObjectivesNursing homes (NHs) care for 70% of Americans dying with dementia. Many consider deaths in NHs rather than hospitals as preferable for most of these residents. NH characteristics such as staff teamwork, communication, and other components of patient safety culture (PSC), together with state minimum NH nurse staffing requirements, may influence location of death. We examined associations between these variables and place of death (NH/hospital) among residents with dementia.Research Design and MethodsCross-sectional study of 11,957 long-stay NH residents with dementia, age 65+, who died in NHs or hospitals shortly following discharge from one of 800 U.S. NHs in 2017. Multivariable logistic regression systematically estimated effects of PSC on odds of in-hospital death among residents with dementia, controlling for resident, NH, county, and state characteristics. Logistic regressions also determined moderating effects of state minimum NH nurse staffing requirements on relationships between key PSC domains and location of death.ResultsResidents with dementia in NHs with higher PSC scores in communication openness had lower odds of in-hospital death. This effect was stronger in NHs located in states with higher minimum NH nurse staffing requirements.Discussion and ImplicationsPromoting communication openness in NHs across nursing disciplines may help avoid unnecessary hospitalization at the end of life, and merits particular attention as NHs address nursing staff mix while adhering to state staffing requirements. Future research to better understand unintended consequences of staffing requirements is needed to improve end-of-life care in NHs.