title: Acute care practices relevant to quality end-of-life care: a survey of Pennsylvania hospitals.
abstract: 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.
authors.affiliation: 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.
authors.forename: C Y
authors.initials: CY
authors.lastname: Lin
authors.forename: R M
authors.initials: RM
authors.lastname: Arnold
authors.forename: J R
authors.initials: JR
authors.lastname: Lave
authors.forename: D C
authors.initials: DC
authors.lastname: Angus
authors.forename: A E
authors.initials: AE
authors.lastname: Barnato
mesh_terms: 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