title: Site of death among nursing home residents in the United States: changing patterns, 2003-2007.
abstract: BACKGROUND
  The proportion of US deaths occurring in nursing homes (NHs) has been increasing in the past 2 decades and is expected to reach 40% by 2020. Despite being recognized as an important setting in the provision of end-of-life (EOL) care, little is known about the quality of care provided to dying NH residents. There has been some, but largely anecdotal evidence suggesting that many US NHs transfer dying residents to hospitals, in part to avoid incurring the cost of providing intensive on-site care, and in part because they lack resources to appropriately serve the dying residents. We assessed longitudinal trends and geographic variations in place of death among NH residents, and examined the association between residents' characteristics, treatment preferences, and the probability of dying in hospitals.
  
  
  METHODS
  We used the Minimum Data Set (NH assessment records), Medicare denominator (eligibility) file, and Medicare inpatient and hospice claims to identify decedent NH residents. In CY2003-2007, there were 2,992,261 Medicare-eligible NH decedents from 16,872 US Medicare- and/or Medicaid-certified NHs. Our outcome of interest was death in NH or in a hospital. The analytical strategy included descriptive analyses and multiple logistic regression models, with facility fixed effects, to examine risk-adjusted temporal trends in place of death.
  
  
  RESULTS
  Slightly more than 20% of decedent NH residents died in hospitals each year. Controlling for individual-level risk factors and for facility fixed effects, the likelihood of residents dying in hospitals has increased significantly each year between 2003 through 2007.
  
  
  CONCLUSIONS
  This study fills a significant gap in the current literature on EOL care in US nursing homes by identifying frequent facility-to-hospital transfers and an increasing trend of in-hospital deaths. These findings suggest a need to rethink how best to provide care to EOL nursing home residents.
authors.affiliation: Department of Public Health Sciences, Center for Ethics, Humanities and Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY. Electronic address: Helena_Temkin-Greener@urmc.rochester.edu.
authors.forename: Helena
authors.initials: H
authors.lastname: Temkin-Greener
authors.forename: Nan Tracy
authors.initials: NT
authors.lastname: Zheng
authors.forename: Jingping
authors.initials: J
authors.lastname: Xing
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
mesh_terms: D016223:Advance Directives / Q000706:statistics & numerical data; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data / Q000639:trends; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare; D009369:Neoplasms / Q000401:mortality; D009735:Nursing Homes / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data; D016414:Resuscitation Orders; D012189:Retrospective Studies; D017678:Sex Distribution; D013727:Terminal Care; D019452:Terminally Ill / Q000706:statistics & numerical data; D014187:Transportation of Patients; D014481:United States
keywords: Nursing homes; hospitalization; place of death