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Project reduces nursing home transfers at EOL
Few nursing homes have a reliable process to help residents understand and document their end-of-life wishes, nor adequate procedures to care for them when they are dying. As a result, residents are often hospitalized during the last weeks or months of life, causing unnecessary suffering and possibly driving up health care costs.
A recent regional initiative of the California Healthcare Foundation, the PREPARED project, sought to reduce such transfers by improving advance care planning, including use of Physician Orders for Life Sustaining Treatment (POLST). The intervention included hospital-provided clinician educators assigned to nursing homes to offer education, role modeling, and coaching of key staff.
An evaluation of the project showed a statistically significant increase in the nursing home as the site of death for residents who died and a modest reduction in hospitalizations from 9.6 per month per facility to 8.9. There was a 6% increase in family members' overall rating of their dying loved one's quality of care and a 13% decrease in the number of family members who thought that their dying loved one was not always treated with respect.
Factors that contributed to progress in some facilities included:
Sustained administrative support and leadership;
Facility advance care planning champions and involved physicians;
A focus on quality improvement; and
Opportunities for resident and family education.
To see a copy of the report go to www.chcf.org and select "Publications" on the top navigational bar, then choose "Current Publications." Scroll down to "Be Prepared: Reducing Nursing Home Transfers Near End of Life."