title: Palliative care for long-term care residents: effect on clinical outcomes.
abstract: OBJECTIVE
  To determine whether a palliative care (PC) consult service in a long-term care (LTC) facility would result in a more favorable course of treatment and clinical outcomes for participating residents.
  
  
  METHODS
  We used a historical control design within a single LTC facility. Outcome data and potential confounding variables were obtained using the Minimum Data Set. (Health Care Financing Administration. (1995). Long term care resident assessment instrument user's manual version 2.0. Rockville, MD: Health Care Financing Administration.) Residents who died during the period of the PC service (2007-2009) were compared with matched residents who died in the year prior (2006, historical controls). The analysis sample included 250 residents (125 PC residents, 125 non-PC historical control residents). Our main analysis focused on a composite outcome based on utilization patterns, depression, and pain and other clinical indicators. We analyzed change on this component score (and the individual outcomes) over a 1-year period.
  
  
  RESULTS
  PC residents experienced a significant reduction in emergency room (ER) visits (p < .001) and depression (p = .031). Change in the composite score indicated a significant difference over time between the 2 groups (p = .013).
  
  
  CONCLUSIONS
  Although limited to 1 facility and drawn from a quasi-experimental design, the results demonstrate the potential for improved quality of care with PC consults. The PC team was effective in reducing ER visits and depression and promoted more appropriate care resulting in more favorable clinical outcomes toward the resident's end of life.
authors.affiliation: Address correspondence to Jody Comart, Palliative Care, Hebrew Rehabilitation Center, 1200 Centre St., Boston, MA 02131. E-mail: jodycomart@hsl.harvard.edu.
authors.forename: Jody
authors.initials: J
authors.lastname: Comart
authors.forename: Anne
authors.initials: A
authors.lastname: Mahler
authors.forename: Robert
authors.initials: R
authors.lastname: Schreiber
authors.forename: Christopher
authors.initials: C
authors.lastname: Rockett
authors.forename: Richard N
authors.initials: RN
authors.lastname: Jones
authors.forename: John N
authors.initials: JN
authors.lastname: Morris
mesh_terms: D000369:Aged, 80 and over; D003863:Depression; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000379:methods*; D010347:Patient Care Planning; D011787:Quality of Health Care; D011788:Quality of Life; D012017:Referral and Consultation; D013727:Terminal Care / Q000379:methods*