Impact of Nursing Home Palliative Care Teams on End-of-Life Outcomes

A Randomized Controlled Trial

Datos Bibliográficos

ID9099052
AutoresHelena Temkin‐greener (0000-0001-6113-2953, University of Rochester, autor de correspondencia), Helena Temkin-Greener (Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY), Dana B Mukamel (0000-0003-4147-5785, Department of Medicine, iTEQC Research Program University of California), Heather Ladd (0000-0003-4427-7178, Department of Medicine, University of California, Irvine, CA), Susan Ladwig (Department of Medicine, University of Rochester School of Medicine and Dentistry), Thomas V Caprio (0000-0002-7216-7358, Department of Medicine, University of Rochester School of Medicine and Dentistry), Sally A Norton (0000-0001-7686-6327, University of Rochester), Timothy E Quill (Department of Medicine, University of Rochester School of Medicine and Dentistry), Tobie H Olsan (University of Rochester), Tobie Olsan (University of Rochester), Xueya Cai (0000-0001-7922-2703, University of Rochester)
Año2018
Volumen56
Número1
Páginas11-18
Fecha de publicación2018-01-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000835
PMID29068904
OpenAlexW2766364781
IdiomaEN
Referencias citadas29

BACKGROUND: Deficits in end-of-life care in nursing homes (NHs) are reported, but the impact of palliative care teams (PCTeams) on resident outcomes remains largely untested. OBJECTIVE: Test the impact of PCTeams on end-of-life outcomes. RESEARCH DESIGN: Multicomponent strategy employing a randomized, 2-arm controlled trial with a difference-in-difference analysis, and a nonrandomized second control group to assess the intervention's placebo effect. SUBJECTS: In all, 25 New York State NHs completed the trial (5830 decedent residents) and 609 NHs were in the nonrandomized group (119,486 decedents). MEASURES: Four risk-adjusted outcome measures: place of death, number of hospitalizations, self-reported moderate-to-severe pain, and depressive symptoms. The Minimum Data Set, vital status files, staff surveys, and in-depth interviews were employed. For each outcome, a difference-in-difference model compared the pre-post intervention periods using logistic and Poisson regressions. RESULTS: Overall, we found no statistically significant effect of the intervention. However, independent analysis of the interview data found that only 6 of the 14 treatment facilities had continuously working PCTeams throughout the study period. Decedents in homes with working teams had significant reductions in the odds of in-hospital death compared to the other treatment [odds ratio (OR), 0.400; P<0.001), control (OR, 0.482; P<0.05), and nonrandomized control NHs (0.581; P<0.01). Decedents in these NHs had reduced rates of depressive symptoms (OR, 0.191; P≤0.01), but not pain or hospitalizations. CONCLUSIONS: The intervention was not equally effective for all outcomes and facilities. As homes vary in their ability to adopt new care practices, and in their capacity to sustain them, reforms to create the environment in which effective palliative care can become broadly implemented are needed

Alternative medicine · Intervention (counseling) · Logistic regression · Minimum Data Set · Nursing homes · Odds · Odds ratio · Palliative care · Physical therapy · Placebo · Poisson regression · Population · Randomized controlled trial · Emergency Medicine · Frailty in Older Adults · Geriatric Care and Nursing Homes · Internal Medicine · Medicine · Nursing · Palliative Care and End-of-Life Issues