End-of-life culture change practices in U.S. nursing homes in 2016 / 2017

Article

SCHWARTZ, Margot L. | LIMA, Julie C. | CLARK, Melissa A. | MILLER, Susan C.

CONTEXT: The Nursing Home (NH) culture change (CC) movement, which emphasizes person-centered care, is particularly relevant to meeting the unique needs of residents near the end-of-life (EOL). OBJECTIVES: We aimed to evaluate the NH-reported adoption of person-centered EOL-CC practices and identify NH characteristics associated with greater adoption. METHODS: We used NH and state policy data for 1,358 NHs completing a nationally representative 2016/17 NH Culture Change Survey. An 18-point EOL-CC score was created by summarizing responses from six survey items related to practices for residents who were dying/had died. NHs were divided into quartiles reflecting their EOL-CC score, and multivariable ordered logistic regression was used to identify NH characteristics associated with having higher (quartile) scores. RESULTS: The mean EOL-CC score was 13.7 (standard deviation=3.0). Correlates of higher scores differed from those previously found for non-EOL-CC practices. Higher NH leadership scores and non-profit status were consistently associated with higher EOL-CC scores. For example, a three-point leadership score increase was associated with higher odds of a NH performing in the top EOL-CC quartile (OR=2.0, 95% CI:1.82, 2.30), while for-profit status was associated with lower odds (OR=.0.7, 95% CI:0.49,0.90). The availability of palliative care (PC) consults was associated with a greater likelihood of EOL-CC scores above the median (OR=1.5, 95%CI: 1.10,1.93), but not in the top or bottom quartiles. CONCLUSION: NH-reported adoption of EOL-CC practices varies, and the presence of PC consults in NHs explains only some of this variation. Findings support the importance of evaluating EOL-CC practices separately from other culture change practices.

http://dx.doi.org/10.1016/j.jpainsymman.2018.12.330

Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT»

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