Palliative Care Consultations in Nursing Homes and Reductions in Acute Care Use and Potentially Burdensome End-of-Life Transitions.

Abstract

OBJECTIVES:

To evaluate how receipt and timing of nursing home (NH) palliative care consultations (primarily by nurse practitioners with palliative care expertise) are associated with end-of-life care transitions and acute care use DESIGN: Propensity score-matched retrospective cohort study.

SETTING:

Forty-six NHs in two states.

PARTICIPANTS:

Nursing home residents who died from 2006 to 2010 stratified according to days between initial consultation and death (≤7, 8-30, 31-60, 61-180). Propensity score matching identified three controls (n = 1,174) according to strata for each consultation recipient (n = 477).

MEASUREMENTS:

Outcomes were hospitalizations in the last 7, 30, and 60 days of life; emergency department (ED) visits in the last 30 and 60 days; and any potentially burdensome care transition, defined as hospitalization or hospice admission within 3 days of death or two or more hospitalizations or ED visits within 30 days. Weighted multivariate logistic regression analyses were used to evaluate outcomes.

RESULTS:

Residents with consultations had lower rates of hospitalization than controls, with rates lowest when initial consultations were furthest from death. For instance, in residents with initial consultations 8 to 30 days before death, the adjusted hospitalization rate in the last 7 days of life was 11.1% (95% confidence interval (CI) = 9.8-12.4%), vs 22.0% (95% CI = 20.6-23.4%) in controls, although in those with initial consultations 61 to 180 days before death, rates were 6.9% (95% CI = 5.5-8.4%), vs 22.9% (95% CI = 20.5-25.4%). Potentially burdensome transition rates were lower when consultations were 61 to 180 days before death (16.2%, 95% CI = 13.7-18.6%), vs 28.2% (95% CI = 25.8-30.6%) for controls.

CONCLUSION:

Palliative care consultations improve end-of-life NH care by reducing acute care use and potentially burdensome care transitions.

• Authors: Susan C Miller, Julie C Lima, Orna Intrator, Edward Martin, Janet Bull, Laura C Hanson
• Journal: Journal of the American Geriatrics Society (J Am Geriatr Soc) Vol. 64 Issue 11 Pg. 2280-2287 (11 2016) ISSN: 1532-5415 [Electronic] United States
• PMID: 27641157 (Publication Type: Journal Article)
• Copyright: © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Topics

• Aged, 80 and over
• Emergency Service, Hospital (statistics & numerical data)
• Female
• Geriatric Assessment
• Hospice Care (statistics & numerical data)
• Hospitalization (statistics & numerical data)
• Humans
• Male
• Medicare
• Nursing Homes
• Palliative Care
• Propensity Score
• Quality Improvement
• Quality of Life
• Referral and Consultation
• Retrospective Studies
• Socioeconomic Factors
• Terminal Care
• United States