Rural-Urban Differences in End-of-Life Nursing Home Care: Facility and Environmental Factors

Autor/inn/en	Temkin-Greener, Helena; Zheng, Nan Tracy; Mukamel, Dana B.
Titel	Rural-Urban Differences in End-of-Life Nursing Home Care: Facility and Environmental Factors
Quelle	In: Gerontologist, 52 (2012) 3, S.335-344 (10 Seiten) PDF als Volltext Verfügbarkeit
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	0016-9013
DOI	10.1093/geront/gnr143
Schlagwörter	Hospices (Terminal Care); Community Characteristics; Municipalities; Hospitals; Risk; Rural Urban Differences; Nursing Homes; Health Facilities; Regression (Statistics); Terminal Illness; Health Services; Patients; Multivariate Analysis; Pain + Suchen Sie Ihr Suchwort? Hospice; Hospiz; Magistrat; Krankengymnast; Krankenhaus; Risiko; Stadt-Land-Beziehung; Sonderheim; Gesundheitszentrum; Regression; Regressionsanalyse; Health service; Gesundheitsdienst; Gesundheitswesen; Patient; Multivariate Analyse; Schmerz
Abstract	Purpose of the study: This study examines urban-rural differences in end-of-life (EOL) quality of care provided to nursing home (NH) residents. Data and Methods: We constructed 3 risk-adjusted EOL quality measures (QMs) for long-term decedent residents: in-hospital death, hospice referral before death, and presence of severe pain. We used CY2005-2007 100% Minimum Data Set, Medicare beneficiary file, and inpatient and hospice claims. Logistic regression models were estimated to predict the probability of each outcome conditional on decedents' risk factors. For each facility, QMs were calculated as the difference between the actual and the expected risk-adjusted outcome rates. We fit multivariate linear regression models, with fixed state effects, for each QM to assess the association with urban-rural location. Results: We found urban-rural differences for in-hospital death and hospice QMs, but not for pain. Compared with NHs located in urban areas, facilities in smaller towns and in isolated rural areas have significantly (p less than 0.001) worse EOL quality for in-hospital death and hospice use. Whereas the differences in these QMs are statistically significant between facilities located in large versus small towns, they are not statistically significant between facilities located in small towns and isolated rural areas. Implications: This study provides empirical evidence for urban-rural differences in EOL quality of care using a national sample of NHs. Identifying differences is a necessary first step toward improving care for dying NH residents and for bridging the urban-rural gap. (As Provided).
Anmerkungen	Oxford University Press. Great Clarendon Street, Oxford, OX2 6DP, UK. Tel: +44-1865-353907; Fax: +44-1865-353485; e-mail: jnls.cust.serv@oxfordjournals.org; Web site: http://gerontologist.oxfordjournals.org
Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2017/4/10