End-of-life transitions among nursing home residents with cognitive issues.
Pedro Gozalo,Joan M. Teno,Susan L. Mitchell,Jon Skinner,Julie P.W. Bynum,Denise Tyler,Vincent Mor +6 more
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Burdensome transitions are common, vary according to state, and are associated with markers of poor quality in end-of-life care.Abstract:
Background Health care transitions in the last months of life can be burdensome and potentially of limited clinical benefit for patients with advanced cognitive and functional impairment. Methods To examine health care transitions among Medicare decedents with advanced cognitive and functional impairment who were nursing home residents 120 days before death, we linked nationwide data from the Medicare Minimum Data Set and claims files from 2000 through 2007. We defined patterns of transition as burdensome if they occurred in the last 3 days of life, if there was a lack of continuity in nursing homes after hospitalization in the last 90 days of life, or if there were multiple hospitalizations in the last 90 days of life. We also considered various factors explaining variation in these rates of burdensome transition. We examined whether there was an association between regional rates of burdensome transition and the likelihood of feeding-tube insertion, hospitalization in an intensive care unit (ICU) in the...read more
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