Integration of Palliative Care and Infection Management at the End of Life in U.S. Nursing Homes.

Abstract

Infections in nursing home (NH) residents are often terminal illnesses. Integration of palliative care (PC) and infection management (IM) is a new concept that can help reduce burdensome treatments and improve quality of care for NH residents at the end of life. To develop measures of integration, describe the integration in U.S. NHs, and examine predictors of integration. A nationally representative sample of NHs was surveyed. An instrument to measure integration was tested using factor analyses. Descriptive analyses of each integration factor were conducted, construct validity was examined using correlations between the integration factors and validated measures of PC and IM, and multivariable linear regression models were developed to identify NH characteristics associated with integration. A total of 892 NH surveys were returned (49% response rate), 859 with complete data. Three integration factors were identified: patient involvement in care planning (Involvement), formalized advance care planning (Advance Care Planning), and routine practices of integration (Routine Practices). The highest level of integration in NHs was reported for Involvement (mean (μ) = 73.2, standard error [SE] = 1.57), with lower rates for Advance Care Planning and Routine Practices (respectively, μ = 34.1, SE = 1.05; μ = 31.4, SE = 1.48). Each integration measure was weakly, positively associated with the PC and IM measures (r ≤ 0.25, P ≤ 0.01). There were few associations between NH characteristics and integration. Integration is a distinct concept that is associated with, but different from, PC and IM. Results serve as a baseline assessment of integration in NHs. Continued refinement of the integration instrument is recommended, as is studying if higher integration leads to better resident outcomes.