@article{
 title = {End-of-Life Care in Nursing Homes: From Care Processes to Quality},
 type = {article},
 year = {2016},
 identifiers = {[object Object]},
 month = {8},
 day = {16},
 city = {1 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York.; 2 RTI , International, Massachusetts.; 1 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistr},
 id = {3a14fabe-1675-3125-9d53-d798029870fa},
 created = {2016-08-21T22:19:07.000Z},
 file_attached = {false},
 profile_id = {217ced55-4c79-38dc-838b-4b5ea8df5597},
 group_id = {408d37d9-5f1b-3398-a9f5-5c1a487116d4},
 last_modified = {2017-03-14T09:54:45.334Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 source_type = {JOUR},
 notes = {LR: 20160816; JID: 9808462; aheadofprint},
 folder_uuids = {71fbba75-e161-4e51-9ee7-56ceb6d78e54,06271a48-ad48-43cc-b073-52e57f10f5e1},
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 abstract = {BACKGROUND/OBJECTIVE: 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. DESIGN AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.},
 bibtype = {article},
 author = {Temkin-Greener, H and Li, Q and Li, Y and Segelman, M and Mukamel, D B},
 journal = {Journal of palliative medicine}
}

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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. DESIGN AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.","bibtype":"article","author":"Temkin-Greener, H and Li, Q and Li, Y and Segelman, M and Mukamel, D B","journal":"Journal of palliative medicine","bibtex":"@article{\n title = {End-of-Life Care in Nursing Homes: From Care Processes to Quality},\n type = {article},\n year = {2016},\n identifiers = {[object Object]},\n month = {8},\n day = {16},\n city = {1 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York.; 2 RTI , International, Massachusetts.; 1 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistr},\n id = {3a14fabe-1675-3125-9d53-d798029870fa},\n created = {2016-08-21T22:19:07.000Z},\n file_attached = {false},\n profile_id = {217ced55-4c79-38dc-838b-4b5ea8df5597},\n group_id = {408d37d9-5f1b-3398-a9f5-5c1a487116d4},\n last_modified = {2017-03-14T09:54:45.334Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n source_type = {JOUR},\n notes = {LR: 20160816; JID: 9808462; aheadofprint},\n folder_uuids = {71fbba75-e161-4e51-9ee7-56ceb6d78e54,06271a48-ad48-43cc-b073-52e57f10f5e1},\n private_publication = {false},\n abstract = {BACKGROUND/OBJECTIVE: Nursing homes (NHs) are an important setting for the provision of palliative and end-of-life (EOL) care. 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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. RESULTS: 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. CONCLUSIONS: 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. 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