title: Nursing home physician educational intervention improves end-of-life outcomes.
abstract: BACKGROUND
  Nursing homes are the setting for one of five deaths in the United States. Unfortunately these deaths are often accompanied by pain and symptoms of discomfort.
  
  
  OBJECTIVE
  To determine if an educational intervention designed for nursing home physicians improves the quality of dying for nursing home residents.
  
  
  METHODS
  Prospective measurement of changes in end-of-life medical care indicators.
  
  
  METHODS
  Half-day adult educational outreach program, including audit and feedback, targeted at opinion leaders, and quality improvement suggestions.
  
  
  METHODS
  Five geographically diverse Maryland skilled nursing facilities with a total of 654 beds.
  
  
  METHODS
  The terminal care delivered by 61 physicians who cared for 203 dying residents in the 5 facilities was reviewed. An intervention was targeted to medical directors and those physicians with the majority of patients. Twelve physicians participated in the educational program.
  
  
  METHODS
  Chart documentation of recognition of possible death, presence of advance directives, pain control, analgesics used, dyspnea control, control of uncomfortable symptoms during the dying process, documented hygiene, documented bereavement support, and total patient comfort.
  
  
  RESULTS
  The four nursing facilities that completed the intervention all had significant improvements in end-of-life care outcomes (p < 0.001, chi2). No statistically significant changes were found in any measure in the cohort nursing facility that did not complete the intervention. When we compared residents with hospice services to those without, we found significant increases in documentation of better hygiene, bereavement support, and total patient comfort (p < 0.001, chi2 for each).
  
  
  CONCLUSIONS
  Important terminal care outcomes can be significantly improved by targeting key nursing home physicians with an adult educational program that includes audit and feedback, and quality improvement suggestions.
authors.affiliation: Department of Family Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. tkeay@umaryland.edu
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Keay
authors.forename: Carla
authors.initials: C
authors.lastname: Alexander
authors.forename: Karen
authors.initials: K
authors.lastname: McNally
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Crusse
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Eger
mesh_terms: D003479:Curriculum; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D006801:Humans; D008396:Maryland; D008485:Medical Audit; D009735:Nursing Homes / Q000592:standards*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011787:Quality of Health Care; D013727:Terminal Care / Q000592:standards*