This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Keay, T. J. Articles by Levenson, S. A. Search for Related Content PubMed PubMed Citation Articles by Keay, T. J. Articles by Levenson, S. A. Pubmed/NCBI databases Medline Plus Health Information Nursing Homes Social Bookmarking                         What's this?

Assessing Medical Care of Dying Residents in Nursing Homes

Department of Family Medicine Univ of Maryland School of Medicine, Baltimore, Maryland

George A. Taler, M.D.

Department of Family Medicine Univ of Maryland School of Medicine, Baltimore, Maryland

Lisa Fredman, Ph.D.

Epidemiology, University of Maryland School of Medicine, Baltimore, Maryland

Steven A. Levenson, M.D.

Genesis ElderCare, Towson, Maryland

Although approximately one of five people in the United States die in nursing homes (NHs), little has been written about their quality of dying, including the quality of terminal medical care. The purpose of this study is to review actual medical practices in NHs to suggest factors important for delivering good quality terminal care. Four NHs were surveyed for management of residents who died in 1992. A convenience sample of charts of newly admitted and longer term residents were abstracted for demographic variables, death, diagnostic categories, and various laboratory and other parameters. Charts of those residents who died were further reviewed using indicators of quality medical care, such as presence of advance directives, control of pain, and control of dyspnea, based upon recent published clinical practice guidelines for terminal care in NHs. Three hundred and seventy-one charts were abstracted. Forty-one charts documented the resident's death. We found that NHs without regulatory difficulties usually had expected deaths that were managed appropriately as measured by terminal medical care quality indicators. NHs with a history of regulatory difficulties had a higher prevalence of residents who died suddenly and unexpectedly, often with problems in the quality of care as measured by the same indicators. There was a correspondence between physician certification, antemortem diagnosis of terminal illness, and appropriate terminal care. We conclude that physicians are able to recognize impending death and redirect the medical care of dying NH residents toward goals of terminal care management. This is more likely to occur in a NH environment that places greater emphasis upon total quality management. We suggest that another indicator in providing good NH terminal care is the physician's performance in predicting a short life expectancy.

American Journal of Medical Quality, Vol. 12, No. 3, 151-156 (1997)
DOI: 10.1177/106286069701200303


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?