249986 End-of-Life Quality of Care in Nursing Homes: Rural-Urban Disparities

Tuesday, November 1, 2011: 8:30 AM

Helena Temkin-Greener, PhD , Department of Community and Preventive Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY
Nan Tracy Zheng, PhD , Aging, Disability and Long Term Care, RTI International, Waltham, MA
Dana B. Mukamel, PhD , Department of Medicine, Health Policy Research Institute, University of California, Irvine, Irvine, CA
Differences in rural-urban practice styles and quality-of-care in nursing homes (NHs) were demonstrated in prior studies, but little is known about variations in end-of-life (EOL) quality. Our study examines this issue.

We constructed four risk-adjusted EOL quality measures (QMs) for long-term decedent residents: in-hospital-death; no hospice referral before death; pain; and dyspnea.

We used CY2005-2007 Minimum Data Set, Medicare beneficiary file, inpatient and hospice claims, Online Survey Certification and Reporting System and Rural-Urban Commuting Area Codes.

We estimated logistic regression models predicting the probability of each outcome conditional on decedents' risk factors (n=898,964 decedents). We then calculated QMs for each facility (n=14,611), as the difference between the actual and the expected risk-adjusted outcome rates.

To examine the association between EOL QMs and rurality, we fit multivariate linear regressions, with fixed state effects, for each QM (dependent variable). NH location categorized as urban, large-town, small-town, isolated-rural was the key variable of interest. Independent variables included: ownership, staffing, size, case mix, payer mix, etc.

Rural-urban disparities were found for all QMs. For example, for the in-hospital-death QM, we found that compared to urban NHs, facilities in large and small towns, and in isolated-rural areas, had worse (p<0.001) QMs (i.e. higher observed in-hospital-death rates than the risk-adjusted national average). QMs were significantly worse in small-town (p<.001) and in isolated-rural (p=0.039) NHs compared to large-town NHs.

We provide empirical evidence for rural-urban disparities in EOL quality of care. Identifying disparities is a necessary first step towards improving care for dying NH residents.

Learning Areas:
Public health or related public policy
Public health or related research

Learning Objectives:
1) Assess rural-urban disparities in end-of-life care in nursing homes.

Keywords: End-of-Life Care, Nursing Homes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: this is my area of professional research expertise
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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