Prototype End-of-Life Quality Measures Based on MDS 3 Data

Background: The Nursing Home Compare (NHC) report card does not include end-of-life (EOL) quality measures (QMs). Objectives: To develop and examine the properties of EOL QMs. Subjects: A total of 39,590 nursing home decedents in 626 facilities in New York State in fiscal year 2012. Design: Statistical analyses of Minimum Data Set 3 data, including multivariable regression analyses and descriptive statistics. Measures: Death in the hospital, number of hospitalizations, pain, and depression during the last 90 days before death. Results: Overall, 32% of residents died in the hospital. They averaged 0.49 hospitalizations in the last 90 days before death, 10% reported moderate to severe pain, and 17% had depressive symptoms. The EOL QMs exhibited variation across facilities similar to that observed for other QMs. They showed low or moderate correlations. The pain and depression QMs were significantly better among nursing homes ranked by NHC as 4 and 5 stars compared with those ranked as 1 and 2 stars for most dimensions. The hospitalizations QMs were significantly better among nursing homes ranked by NHC as 4 and 5 stars compared with those ranked as 1 and 2 stars only when compared on the staffing dimension. Conclusions: The Minimum Data Set 3 includes much information that can be used to assess quality of EOL care in nursing homes. The prototype measures we developed could be improved if information about advance directives and the nonclinical aspects of care, such as comfort and emotional support for both the resident and the family and respect for resident and family preferences, were collected.

https://www.jstor.org/stable/26418258