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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR010727-04
Application #
8120462
Study Section
Nursing Science: Adults and Older Adults Study Section (NSAA)
Program Officer
Aziz, Noreen M
Project Start
2008-09-30
Project End
2013-07-31
Budget Start
2011-08-01
Budget End
2013-07-31
Support Year
4
Fiscal Year
2011
Total Cost
$331,961
Indirect Cost
Name
University of Rochester
Department
Public Health & Prev Medicine
Type
Schools of Dentistry
DUNS #
041294109
City
Rochester
State
NY
Country
United States
Zip Code
14627
Zheng, Nan Tracy; Mukamel, Dana B; Friedman, Bruce et al. (2015) The effect of hospice on hospitalizations of nursing home residents. J Am Med Dir Assoc 16:155-9
Ye, Zhiqiu; Mukamel, Dana B; Huang, Susan S et al. (2015) Healthcare-associated pathogens and nursing home policies and practices: results from a national survey. Infect Control Hosp Epidemiol 36:759-66
Temkin-Greener, Helena; Zheng, Nan Tracy; Xing, Jingping et al. (2013) Site of death among nursing home residents in the United States: changing patterns, 2003-2007. J Am Med Dir Assoc 14:741-8
Mukamel, Dana B; Ladd, Heather; Temkin-Greener, Helena (2013) Stability of cardiopulmonary resuscitation and do-not-resuscitate orders among long-term nursing home residents. Med Care 51:666-72
Li, Qinghua; Zheng, Nan Tracy; Temkin-Greener, Helena (2013) Quality of end-of-life care of long-term nursing home residents with and without dementia. J Am Geriatr Soc 61:1066-73
Xing, Jingping; Mukamel, Dana B; Temkin-Greener, Helena (2013) Hospitalizations of nursing home residents in the last year of life: nursing home characteristics and variation in potentially avoidable hospitalizations. J Am Geriatr Soc 61:1900-8
Temkin-Greener, Helena; Zheng, Nan Tracy; Mukamel, Dana B (2012) Rural-urban differences in end-of-life nursing home care: facility and environmental factors. Gerontologist 52:335-44
Mukamel, Dana B; Caprio, Thomas; Ahn, Richard et al. (2012) End-of-life quality-of-care measures for nursing homes: place of death and hospice. J Palliat Med 15:438-46
Zheng, Nan Tracy; Mukamel, Dana B; Caprio, Thomas et al. (2011) Racial disparities in in-hospital death and hospice use among nursing home residents at the end of life. Med Care 49:992-8
Zheng, Nan Tracy; Temkin-Greener, Helena (2010) End-of-life care in nursing homes: the importance of CNA staff communication. J Am Med Dir Assoc 11:494-9

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