Acute care practices relevant to quality end-of-life care: a survey of Pennsylvania hospitals.
BACKGROUND
Improving end-of-life care in the hospital is a national priority.


OBJECTIVE
To explore the prevalence and reasons for implementation of hospital-wide and intensive care unit (ICU) practices relevant to quality care in key end-of-life care domains and to discern major structural determinants of practice implementation.


METHODS
Cross-sectional mixed-mode survey of chief nursing officers of Pennsylvania acute care hospitals.


RESULTS
The response rate was 74% (129 of 174). The prevalence of hospital and ICU practices ranged from 95% for a hospital-wide formal code policy to 6% for regularly scheduled family meetings with an attending physician in the ICU. Most practices had less than 50% implementation; most were implemented primarily for quality improvement or to keep up with the standard of care. In a multivariable model including hospital structural characteristics, only hospital size independently predicted the presence of one or more hospital initiatives (ethics consult service, OR 6.13, adjusted p = 0.02; private conference room in the ICU for family meetings, OR 4.54, adjusted p<0.001).


CONCLUSIONS
There is low penetration of hospital practices relevant to quality end-of-life care in Pennsylvania acute care hospitals. Our results may serve to inform the development of future benchmark goals. It is critical to establish a strong evidence base for the practices most associated with improved end-of-life care outcomes and to develop quality measures for end-of-life care to complement existing hospital quality measures that primarily focus on life extension.
Lin
C Y
CY
Center for Research on Health Care and the Institute for Clinical Research Education, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Suite 200, Pittsburgh, PA 15213, USA.
Arnold
R M
RM
Lave
J R
JR
Angus
D C
DC
Barnato
A E
AE
D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D010414:Pennsylvania; D011787:Quality of Health Care; D011788:Quality of Life; D013727:Terminal Care