title: Assessing the Quality of Death and Dying in an Integrated Health Care System in Rural Pennsylvania.
abstract: BACKGROUND
  With growing emphasis on improving the value of health care, there is increased scrutiny of quality outcomes and high health expenditures during the final months of life.
  
  
  OBJECTIVE
  The purpose of this project is to answer 1) how do next of kin (NOK) perceive the quality of their loved ones' dying and death; 2) are there patient and NOK characteristics that predict lower quality; and 3) are there structural aspects of care associated with lower quality?
  
  
  METHODS
  A mailed survey was administered to a stratified random sample of NOK of Geisinger Health System patients who had died in the past year. The Quality of Death and Dying, the General Anxiety Disorder seven-item scale, the Patient Health Questionnaire eight-item depression scale, and selected questions from the Toolkit of Instruments to Measure End of Life Care were used.
  
  
  RESULTS
  There were 672 respondents. Significant predictors of Quality of Death and Dying score were number of doctors involved in care (P = 0.0415), location of death (P < 0.0001), frequency of receiving confusing or contradictory information (P < 0.0001), illness progression (P = 0.0343), Patient Health Questionnaire-2 score (P = 0.0148), and General Anxiety Disorder seven-item scale score (P < 0.0070).
  
  
  CONCLUSIONS
  Several findings suggest that factors such as NOK depression and anxiety, prolonged illness, dying in the hospital, receipt of conflicting information, and confusion around the doctor in charge are associated with lower quality of the dying and death experience for NOK. Further investigation is warranted to facilitate high-quality measurement and the use of measurement results to improve care.
authors.affiliation: Center for Clinical Innovation, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Darer
authors.affiliation: Center for Clinical Innovation, Geisinger Health System, Danville, Pennsylvania, USA. Electronic address: dnclarke@geisinger.edu.
authors.forename: Deseraé N
authors.initials: DN
authors.lastname: Clarke
authors.affiliation: Center for Clinical Innovation, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Sees
authors.affiliation: Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Berger
authors.affiliation: Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: H Lester
authors.initials: HL
authors.lastname: Kirchner
authors.affiliation: Center for Clinical Innovation, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Stametz
authors.affiliation: Center for Bioethics, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D003142:Communication; D003643:Death; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D003863:Depression; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D010820:Physicians; D011785:Quality Assurance, Health Care / Q000379:methods; D011788:Quality of Life; D012424:Rural Population; D013727:Terminal Care / Q000379:methods* / Q000523:psychology; D055815:Young Adult
keywords: End-of-life care; conflicting information; next of kin; quality of dying and death