Site of Death Among Nursing Home Residents in the United States: Changing Patterns, 2003-2007
Site of Death Among Nursing Home Residents in the United States: Changing Patterns, 2003-2007
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DOI：
10.1016/j.jamda.2013.03.009
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发表时间：
2013-10-01
影响因子：
7.6
通讯作者：
Mukamel, Dana B.
中科院分区：
文献类型：
--
作者：
Temkin-Greener, Helena;Zheng, Nan Tracy;Mukamel, Dana B.
在过去的20年里，美国养老院（NHs）的死亡比例一直在增加，预计到2020年将达到40%。尽管被公认为是提供临终关怀的一个重要环境，但人们对为临终的NH居民提供的护理质量知之甚少。有一些，但主要是轶事证据表明，许多美国国家卫生机构将垂死的居民转移到医院，部分原因是为了避免产生提供现场重症监护的成本，部分原因是他们缺乏资源来适当地为垂死的居民提供服务。我们评估了纵向趋势和地理变化的NH居民之间的死亡，并研究居民的特点，治疗偏好，和死亡的概率之间的关联在hospital.Methods：我们使用的最小数据集（NH评估记录），医疗保险分母（资格）文件，医疗保险住院和临终关怀索赔，以确定已故NH居民。在CY 2003 -2007年，有2，992，261名符合Medicare资格的NH死者来自16，872名美国Medicare和/或Medicaid认证的NH。我们关注的结局是在NH或医院死亡。分析策略包括描述性分析和多元Logistic回归模型，设施固定效应，以检查风险调整的时间趋势，取代death.Findings：略多于20%的死者NH居民每年死于医院。控制个人水平的危险因素和设施固定效应，居民在医院死亡的可能性显着增加，每年从2003年到2007年。结论：这项研究填补了一个显着的空白，在目前的文献中，美国养老院的EOL护理，确定频繁的设施到医院的转移和院内死亡的增加趋势。这些研究结果表明，需要重新考虑如何最好地为EOL养老院居民提供护理。版权所有（C）2013 -美国医学主任协会，Inc.
Context: The proportion of US deaths occurring in nursing homes (NHs) has been increasing in the past 2 decades and is expected to reach 40% by 2020. Despite being recognized as an important setting in the provision of end-of-life (EOL) care, little is known about the quality of care provided to dying NH residents. There has been some, but largely anecdotal evidence suggesting that many US NHs transfer dying residents to hospitals, in part to avoid incurring the cost of providing intensive on-site care, and in part because they lack resources to appropriately serve the dying residents. We assessed longitudinal trends and geographic variations in place of death among NH residents, and examined the association between residents' characteristics, treatment preferences, and the probability of dying in hospitals.Methods: We used the Minimum Data Set (NH assessment records), Medicare denominator (eligibility) file, and Medicare inpatient and hospice claims to identify decedent NH residents. In CY2003-2007, there were 2,992,261 Medicare-eligible NH decedents from 16,872 US Medicare- and/or Medicaid-certified NHs. Our outcome of interest was death in NH or in a hospital. The analytical strategy included descriptive analyses and multiple logistic regression models, with facility fixed effects, to examine risk-adjusted temporal trends in place of death.Findings: Slightly more than 20% of decedent NH residents died in hospitals each year. Controlling for individual-level risk factors and for facility fixed effects, the likelihood of residents dying in hospitals has increased significantly each year between 2003 through 2007.Conclusions: This study fills a significant gap in the current literature on EOL care in US nursing homes by identifying frequent facility-to-hospital transfers and an increasing trend of in-hospital deaths. These findings suggest a need to rethink how best to provide care to EOL nursing home residents. Copyright (C) 2013 - American Medical Directors Association, Inc.