NIH Awards Rochester $1.7M for Measuring Nursing Home Quality

December 17, 2008

Helena Temkin-Greener, Ph.D., M.P.H.

Little is known about the quality of end-of-life care in nursing homes, but a University of Rochester Medical Center researcher’s $1.7 million grant will fund an innovative set of quality indicators that might eventually be reported to the public.

The issue needs urgent attention, said principal investigator Helena Temkin-Greener, because today, one in three Americans dies in a nursing home. By the year 2020, as the population ages, the number of nursing home deaths is projected to increase by about 40 percent.

“Unfortunately, the health care system does not routinely incorporate end-of-life care measurements into its regular quality assessment reports,” said Temkin-Greener, Ph.D., M.P.H., associate professor of Community and Preventive Medicine. “But based on observations and data from small samples of homes, we do know there is a high incidence of unmanaged pain and other distressing symptoms among patients at the end of their lives, and not enough emphasis on advance care planning or use of hospice services.”

The goal of her national study is to identify individual quality indicators, as well as a composite measure, that would help to assess the end-of-life care in nursing homes. The study would also seek to identify national trends, and look at variations in care across geographic regions and types of facilities.

Individual quality indicators would include criteria such as how well staff manages symptoms (as in pain or depression); aggressiveness of treatment (how often feeding tubes are used, for example); and level of advance care planning (health care proxy usage, for example). Researchers will identify nursing homes that do a particularly good job, and note their characteristics and practices.

The quality of nursing home care has been improving since the introduction in 2003 of publicly available report cards such a Medicare Nursing Home Compare. Still, significant variations exist across nursing homes, which reflect problems in care quality that must be addressed, Temkin-Greener said.

The National Institutes of Health/National Institute of Nursing Research is funding the project through July of 2012.

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