End-of-Life Quality of Care in Nursing Homes

描述(申请人提供)：养老院越来越多地成为老年人护理和死亡的场所。然而，据报道，在临终关怀(EOL)时为养老院居民提供的护理质量不足。美国养老院的EOL护理质量缺乏比较的经验证据，目前还没有疗养院EOL护理质量的风险调整措施。这项拟议研究的目的是开发和验证用于评估养老院EOL护理质量的单个指标和综合措施，并确定与优质EOL护理质量相关的设施的特征。该项目的具体目标是：1)制定和验证单独的和综合的EOL质量指标。2)检查单个指标和综合质量测量中的横向和纵向差异，例如跨州、设施所有权类型等。3)确定与更好的个人和综合质量测量相关的养老院的EOL实践模式和特征。在这项研究过程中开发的措施可以提供一个原型，用于将EOL质量措施纳入公开分发的成绩单中，如医疗保险疗养院比较。从这个项目中获得的经验见解可以用来测试和实施改善养老院EOL护理质量的策略。公共卫生相关性该项目将通过开发一个临终质量措施的原型来改善公共卫生，该原型可纳入公开分发的成绩单，如养老院比较。从该项目中吸取的经验教训可用于实施和测试改善养老院临终关怀质量的战略。

DESCRIPTION (provided by applicant): Nursing homes are increasingly the place of care and death for older persons. However, the quality of care provided to nursing home residents at the end-of-life (EOL) has been reported to be inadequate. Comparative empirical evidence on the quality of EOL care in US nursing homes is lacking and there are currently no risk adjusted measures of EOL quality of care in nursing homes. The objective of the proposed study is to develop and validate individual indicators and a composite measure for assessing EOL quality of care in nursing homes, and to identify characteristics of facilities associated with superior EOL quality of care. The specific aims of this project are to: 1) Develop and validate individual and composite EOL indicators of quality. 2) Examine cross-sectional and longitudinal variations in individual indicators and in the composite quality measure, for example across states, facility ownership type, etc. 3) Identify EOL practice patterns and characteristics of nursing homes that are associated with better individual and composite quality measures. The measures developed in the course of this study could provide a prototype for EOL quality measures to be incorporated into publicly disseminated report cards such as the Medicare Nursing Home Compare. Empirical insights gained from this project may be used to test and implement strategies for improving the quality of EOL care in nursing homes. PUBLIC HEALTH RELEVANCE This project will improve public health by developing a prototype for end-of-life quality measures that could be incorporated into publicly disseminated report cards such as the Nursing Home Compare. Lessons learned from this project may be used to implement and test strategies for improving the quality of end-of-life care in nursing homes.