End-of-Life Culture Change Practices in U.S. Nursing Homes in 2016/2017
dc.contributor.author | Schwartz, Margot L. | |
dc.contributor.author | Lima, Julie C. | |
dc.contributor.author | Clark, Melissa A. | |
dc.contributor.author | Miller, Susan C. | |
dc.date | 2022-08-11T08:10:35.000 | |
dc.date.accessioned | 2022-08-23T17:13:39Z | |
dc.date.available | 2022-08-23T17:13:39Z | |
dc.date.issued | 2019-03-01 | |
dc.date.submitted | 2019-01-23 | |
dc.identifier.citation | <p>J Pain Symptom Manage. 2019 Mar;57(3):525-534. doi: 10.1016/j.jpainsymman.2018.12.330. Epub 2018 Dec 20. <a href="https://doi.org/10.1016/j.jpainsymman.2018.12.330">Link to article on publisher's site</a></p> | |
dc.identifier.issn | 0885-3924 (Linking) | |
dc.identifier.doi | 10.1016/j.jpainsymman.2018.12.330 | |
dc.identifier.pmid | 30578935 | |
dc.identifier.uri | http://hdl.handle.net/20.500.14038/46778 | |
dc.description.abstract | 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. OBJECTIVES: We aimed to evaluate the NH-reported adoption of person-centered end-of-life culture change (EOL-CC) practices and identify NH characteristics associated with greater adoption. METHODS: We used NH and state policy data for 1358 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 (SD = 3.0). Correlates of higher scores differed from those previously found for non-EOL-CC practices. Higher NH leadership scores and nonprofit status were consistently associated with higher EOL-CC scores. For example, a three-point leadership score increase was associated with higher odds of an NH performing in the top EOL-CC quartile (odds ratio [OR] = 2.0, 95% CI: 1.82-2.30), whereas for-profit status was associated with lower odds (OR = 0.7, 95% CI: 0.49-0.90). The availability of palliative care 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 quartile. CONCLUSION: NH-reported adoption of EOL-CC practices varies, and the presence of palliative care consults in NHs explains only some of this variation. Findings support the importance of evaluating EOL-CC practices separately from other culture change practices. | |
dc.language.iso | en_US | |
dc.relation | <p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=30578935&dopt=Abstract">Link to Article in PubMed</a></p> | |
dc.relation.url | https://doi.org/10.1016/j.jpainsymman.2018.12.330 | |
dc.subject | Nursing homes | |
dc.subject | culture change | |
dc.subject | end-of-life | |
dc.subject | palliative care | |
dc.subject | person-centered care | |
dc.subject | Geriatrics | |
dc.subject | Health Psychology | |
dc.subject | Health Services Administration | |
dc.subject | Health Services Research | |
dc.subject | Palliative Care | |
dc.title | End-of-Life Culture Change Practices in U.S. Nursing Homes in 2016/2017 | |
dc.type | Journal Article | |
dc.source.journaltitle | Journal of pain and symptom management | |
dc.source.volume | 57 | |
dc.source.issue | 3 | |
dc.identifier.legacycoverpage | https://escholarship.umassmed.edu/qhs_pp/1238 | |
dc.identifier.contextkey | 13667586 | |
html.description.abstract | <p>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.</p> <p>OBJECTIVES: We aimed to evaluate the NH-reported adoption of person-centered end-of-life culture change (EOL-CC) practices and identify NH characteristics associated with greater adoption.</p> <p>METHODS: We used NH and state policy data for 1358 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.</p> <p>RESULTS: The mean EOL-CC score was 13.7 (SD = 3.0). Correlates of higher scores differed from those previously found for non-EOL-CC practices. Higher NH leadership scores and nonprofit status were consistently associated with higher EOL-CC scores. For example, a three-point leadership score increase was associated with higher odds of an NH performing in the top EOL-CC quartile (odds ratio [OR] = 2.0, 95% CI: 1.82-2.30), whereas for-profit status was associated with lower odds (OR = 0.7, 95% CI: 0.49-0.90). The availability of palliative care 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 quartile.</p> <p>CONCLUSION: NH-reported adoption of EOL-CC practices varies, and the presence of palliative care consults in NHs explains only some of this variation. Findings support the importance of evaluating EOL-CC practices separately from other culture change practices.</p> | |
dc.identifier.submissionpath | qhs_pp/1238 | |
dc.contributor.department | Department of Population and Quantitative Health Sciences | |
dc.source.pages | 525-534 |