End-of-Life Care Transitions in Assisted Living: Associations With State Staffing and Training Regulations.
End-of-Life Care Transitions in Assisted Living: Associations With State Staffing and Training Regulations.
复制标题
辅助生活中的临终关怀过渡：与国家人员配置和培训法规的关联。
DOI：
10.1016/j.jamda.2023.02.002
复制
发表时间：
2023
影响因子：
7.6
通讯作者：
Temkin-Greener,Helena
中科院分区：
文献类型：
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作者：
Guo,Wenhan;Cai,Shubing;Caprio,Thomas;Schwartz,Lindsay;Temkin-Greener,Helena
我们检查了辅助生活社区死者中临终关怀过渡的频率和类别，以及它们与州人员配备和培训法规的关联。设计队列研究。设置和残疾人居住在辅助生活设施中并在2018-2019年验证死亡日期的Medicare受益人（N = 113，662）.MethodsWe used Medicare claims and assessment data for a cohort of assisted living decidents.广义线性模型被用来检查国家人员配备和培训要求和临终关怀过渡之间的关联。临终关怀过渡的频率是关注的结果。国家人员配备和培训法规是关键的协变量。我们控制个人，辅助生活，和区域水平的characteristics. Results-End-of-life护理过渡之间观察到34.89%，我们的研究样本在过去的30天前死亡，和17.25%，在过去的7天。在生命的最后7天内，较高的护理转换频率与持照[发病风险比（IRR）= 1.08;P= 0.002]和直接护理人员配置（IRR = 1.22;P<0.0001）的监管特异性较高相关。直接护理人员培训的监管特异性更高（IRR = 0.75;P<0.0001）与更少的过渡相关。类似的协会被发现为直接护理人员的人员配置（IRR = 1.15;P< .0001）和培训（IRR = 0.79;P< .001）和过渡内30天death. ConclusionsandImplicationsThere有显着的变化，在全国各地的护理过渡的数量。在生命的最后7天或30天内，辅助生活死者之间的临终关怀过渡频率与国家对人员配备和人员培训的监管特异性相关。州政府和辅助生活管理人员可能希望为辅助生活人员配备和培训制定更明确的指导方针，以帮助提高临终关怀的质量。
ObjectiveWe examined the frequency and categories of end-of-life care transitions among assisted living community decedents and their associations with state staffing and training regulations.DesignCohort study.Setting and ParticipantsMedicare beneficiaries who resided in assisted living facilities and had validated death dates in 2018–2019 (N = 113,662).MethodsWe used Medicare claims and assessment data for a cohort of assisted living decedents. Generalized linear models were used to examine the associations between state staffing and training requirements and end-of-life care transitions. The frequency of end-of-life care transitions was the outcome of interest. State staffing and training regulations were the key covariates. We controlled for individual, assisted living, and area-level characteristics.ResultsEnd-of-life care transitions were observed among 34.89% of our study sample in the last 30 days before death, and among 17.25% in the last 7 days. Higher frequency of care transitions in the last 7 days of life was associated with higher regulatory specificity of licensed [incidence risk ratio (IRR) = 1.08;P= .002] and direct care worker staffing (IRR = 1.22;P< .0001). Greater regulatory specificity of direct care worker training (IRR = 0.75;P< .0001) was associated with fewer transitions. Similar associations were found for direct care worker staffing (IRR = 1.15;P< .0001) and training (IRR = 0.79;P< .001) and transitions within 30 days of death.Conclusions and ImplicationsThere were significant variations in the number of care transitions across states. The frequency of end-of-life care transitions among assisted living decedents during the last 7 or 30 days of life was associated with state regulatory specificity for staffing and staff training. State governments and assisted living administrators may wish to set more explicit guidelines for assisted living staffing and training to help improve end-of-life quality of care.