title: End-of-Life Care in Nursing Homes: From Care Processes to Quality.
abstract: Nursing homes (NHs) are an important setting for the provision of palliative and end-of-life (EOL) care. Excessive reliance on hospitalizations at EOL and infrequent enrollment in hospice are key quality concerns in this setting. We examined the association between communication-among NH providers and between providers and residents/family members-and two EOL quality measures (QMs): in-hospital deaths and hospice use.
  
  
  
  We developed two measures of communication by using a survey tool implemented in a random sample of U.S. NHs in 2011-12. Using secondary data (Minimum Data Set, Medicare, and hospice claims), we developed two risk-adjusted quality metrics for in-hospital death and hospice use. In the 1201 NHs, which completed the survey, we identified 54,526 residents, age 65+, who died in 2011. Psychometric assessment of the two communication measures included principal factor and internal consistency reliability analyses. Random-effect logistic and weighted least-square regression models were estimated to develop facility-level risk-adjusted QMs, and to assess the effect of communication measures on the quality metrics.
  
  
  
  Better communication with residents/family members was statistically significantly (p = 0.015) associated with fewer in-hospital deaths. However, better communication among providers was significantly (p = 0.006) associated with lower use of hospice.
  
  
  
  Investing in NHs to improve communication between providers and residents/family may lead to fewer in-hospital deaths. Improved communication between providers appears to reduce, rather than increase, NH-to-hospice referrals. The actual impact of improved provider communication on residents' EOL care quality needs to be better understood.
authors.affiliation: 1 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York.
authors.forename: Helena
authors.initials: H
authors.lastname: Temkin-Greener
authors.affiliation: 2 RTI International, Waltham, Massachusetts.
authors.forename: Qinghua
authors.initials: Q
authors.lastname: Li
authors.affiliation: 1 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York.
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.affiliation: 2 RTI International, Waltham, Massachusetts.
authors.forename: Micah
authors.initials: M
authors.lastname: Segelman
authors.affiliation: 3 Department of Medicine, University of California , Irvine, California.
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
mesh_terms: D000368:Aged; D017051:Hospice Care; D006801:Humans; D006278:Medicare; D009735:Nursing Homes; D011787:Quality of Health Care; D015203:Reproducibility of Results; D013727:Terminal Care; D014481:United States