title: A new model for end-of-life care in nursing homes.
abstract: OBJECTIVE
  This study aimed to promote quality end-of-life (EOL) care for nursing home residents, through the establishment of advance care plan (ACP) and introduction of a new care pathway. This pathway bypassed the emergency room (ER) and acute medical wards by facilitating direct clinical admission to an extended-care facility.
  
  
  METHODS
  An audit on a new clinical initiative that entailed the Community Geriatrics Outreach Service, ER, acute medical wards, and an extended-care facility during winter months in Hong Kong.
  
  
  METHODS
  The participants were older nursing home residents enrolled in an EOL program. We monitored the ratio of clinical to emergency admissions, ACP compliance rate, average length of stay (ALOS) in both acute hospital and an extended-care facility, and mortality rates.
  
  
  RESULTS
  A total of 76 patients were hospitalized from January to March 2013. Of them, 30 (39%) were directly admitted to the extended-care facility, either through the liaison of Community Geriatrics Outreach Service (group A, 19/76, 25%) or transferred from the ER (group B, 11/76, 14%). The remaining 46 patients (group C, 61%) were admitted via the ER to acute medical wards following the usual pathway, followed by transfer to an extended-care facility if indicated. The ACP compliance rate was nearly 100%. In the extended-care unit, groups A and C had similar ALOS of 11.8 and 11.1 days, respectively, whereas group B had a shorter stay of 7.6 days. The ALOS of group C in acute medical wards was 3.5 days. The in-hospital mortality rates were comparable in groups A and C of 26% and 28%, respectively, whereas group B had a lower mortality rate of 18%.
  
  
  CONCLUSIONS
  Nearly 40% of EOL patients could be managed entirely in an extended-care setting without compromising the quality of care and survival. A greater number of patients may benefit from the EOL program by improving the collaboration between community outreach services and ER; and extending hours for direct clinical admission to an extended-care facility.
authors: Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong SAR, China; Department of Community Geriatrics Assessment Team, Prince of Wales Hospital, Hong Kong SAR, China.
authors: Elsie
authors: E
authors: Hui
authors: Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong SAR, China; Department of Community Geriatrics Assessment Team, Prince of Wales Hospital, Hong Kong SAR, China. Electronic address: hmma@cuhk.edu.hk.
authors: Hon Ming
authors: HM
authors: Ma
authors: Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong SAR, China; Department of Community Geriatrics Assessment Team, Prince of Wales Hospital, Hong Kong SAR, China.
authors: Wing Han
authors: WH
authors: Tang
authors: Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong SAR, China.
authors: Wai Sze
authors: WS
authors: Lai
authors: Department of Community Geriatrics Assessment Team, Prince of Wales Hospital, Hong Kong SAR, China.
authors: Ka Ming
authors: KM
authors: Au
authors: Department of Community Geriatrics Assessment Team, Prince of Wales Hospital, Hong Kong SAR, China.
authors: Mei Tak
authors: MT
authors: Leung
authors: Department of Community Geriatrics Assessment Team, Prince of Wales Hospital, Hong Kong SAR, China.
authors: Joey S W
authors: JS
authors: Ng
authors: Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong SAR, China.
authors: Winnie W L
authors: WW
authors: Ng
authors: Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong SAR, China.
authors: Jenny S W
authors: JS
authors: Lee
authors: Department of Community Geriatrics Assessment Team, Prince of Wales Hospital, Hong Kong SAR, China.
authors: Philip K T
authors: PK
authors: Li
authors: Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong SAR, China.
authors: Jean
authors: J
authors: Woo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008485:Medical Audit; D017146:Models, Organizational; D009735:Nursing Homes / Q000458:organization & administration*; D010347:Patient Care Planning / Q000458:organization & administration*; D013727:Terminal Care / Q000458:organization & administration*
keywords: End-of-life; care model; nursing homes