Prototype End-of-Life Quality Measures Based on MDS 3 Data

Area of Science:

• Gerontology
• Health Services Research
• Palliative Care

Background:

• Nursing Home Compare (NHC) lacks end-of-life (EOL) quality measures (QMs).
• Assessing EOL care quality in nursing homes is crucial for improving resident outcomes.

Purpose of the Study:

• To develop and examine the properties of EOL QMs using Minimum Data Set 3 (MDS 3.0) data.
• To evaluate the feasibility and variation of these QMs across nursing facilities.

Main Methods:

• Analysis of MDS 3.0 data from 39,590 nursing home decedents in 626 New York facilities (FY2012).
• Statistical methods included multivariable regression and descriptive statistics.
• Examined outcomes such as hospital death, hospitalizations, pain, and depression in the last 90 days before death.

Main Results:

• 32% of residents died in the hospital; average 0.49 hospitalizations in the last 90 days.
• 10% reported moderate to severe pain; 17% had depressive symptoms.
• EOL QMs showed facility variation; pain and depression QMs correlated with NHC star ratings, while hospitalization QMs correlated with staffing.

Conclusions:

• MDS 3.0 data can effectively assess nursing home EOL care quality.
• Developed prototype EOL QMs show promise but can be enhanced with data on advance directives and nonclinical care aspects.
• Further refinement of EOL QMs is recommended to capture comprehensive quality of care.