Prototype End-of-Life Quality Measures Based on MDS 3 Data.
BACKGROUND
The Nursing Home Compare (NHC) report card does not include end-of-life (EOL) quality measures (QMs).


OBJECTIVE
To develop and examine the properties of EOL QMs.


METHODS
A total of 39,590 nursing home decedents in 626 facilities in New York State in fiscal year 2012.


METHODS
Statistical analyses of Minimum Data Set 3 data, including multivariable regression analyses and descriptive statistics.


METHODS
Death in the hospital, number of hospitalizations, pain, and depression during the last 90 days before death.


RESULTS
Overall, 32% of residents died in the hospital. They averaged 0.49 hospitalizations in the last 90 days before death, 10% reported moderate to severe pain, and 17% had depressive symptoms. The EOL QMs exhibited variation across facilities similar to that observed for other QMs. They showed low or moderate correlations. The pain and depression QMs were significantly better among nursing homes ranked by NHC as 4 and 5 stars compared with those ranked as 1 and 2 stars for most dimensions. The hospitalizations QMs were significantly better among nursing homes ranked by NHC as 4 and 5 stars compared with those ranked as 1 and 2 stars only when compared on the staffing dimension.


CONCLUSIONS
The Minimum Data Set 3 includes much information that can be used to assess quality of EOL care in nursing homes. The prototype measures we developed could be improved if information about advance directives and the nonclinical aspects of care, such as comfort and emotional support for both the resident and the family and respect for resident and family preferences, were collected.
*Medicine-Division of General Internal Medicine, University of California, Irvine, CA †Department of Med-Geriatrics/Aging, University of Rochester ‡Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY.
Dana B
DB
Mukamel
Heather
H
Ladd
Thomas
T
Caprio
Helena
H
Temkin-Greener
D000369:Aged, 80 and over; D003863:Depression / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000592:standards* / Q000706:statistics & numerical data; D010146:Pain / Q000453:epidemiology; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011788:Quality of Life; D013727:Terminal Care / Q000592:standards* / Q000706:statistics & numerical data