ResearchPosted on rand.org Apr 11, 2023Published in: Journal of Palliative Medicine, Volume 24, No. 9, pages 1334-1341 (September 2021). doi: 10.1089/jpm.2020.0577
An estimated 50% of nursing home (NH) residents experience hospital transfers in their last year of life, often due to infections. Hospital transfers due to infection are often of little clinical benefit to residents with advanced illness, for whom aggressive treatments are often ineffective and inconsistent with goals of care. Integration of palliative care and infection management (i.e., merging the goals of palliative care and infection management at end of life) may reduce hospital transfers for residents with advanced illness.
Evaluate the association between integration and (1) all-cause hospital transfers and (2) hospital transfers due to infection.
Cross-sectional observational study.
143,223 U.S. NH residents, including 42,761 residents in the advanced stages of dementia, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD).
Cross-sectional, nationally representative NH survey data (2017-2018) were combined with resident data from the Minimum Data Set 3.0 and Medicare inpatient data (2016-2017). NH surveys measured integration of palliative care and infection management using an index of 0-100. Logistic regression models were used to estimate the relationships between integration intensity (i.e., the degree to which NHs follow best practices for integration) and all-cause hospital transfer and transfer due to infection.
Among residents with advanced dementia, integration intensity was inversely associated with all-cause hospital transfer and transfer due to infection (p<0.001). Among residents with advanced COPD, integration intensity was inversely associated with all-cause hospital transfer (p<0.05) but not transfers due to infection. Among residents with advanced CHF, integration intensity was not associated with either outcome.
NH policies aimed to promote integration of palliative care and infection management may reduce burdensome hospital transfers for residents with advanced dementia. For residents with advanced CHF and COPD, alternative strategies may be needed to promote best practices for infection management at end of life.
This publication is part of the RAND external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.
RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.
