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Indicators of quality medical care for the terminally ill in nursing homes
T J Keay1, L Fredman, G A Taler
1Department of Family Medicine, University of Maryland School of Medicine, Baltimore.
Purpose:
To identify medical care indicators for nursing home terminal care.
Data Sources:
Studies examining care of terminally ill patients were identified using computer, bibliography, and expert searches; input from nursing home medical directors in Maryland; and input from expert geriatricians.
Study Selection:
More than 900 articles, books, and abstracts from meetings covering medical care for terminally ill patients were reviewed. Information from more than 100 publications is included.
Data Extraction:
Indicators of medical care for terminally ill patients, which can be used to quantify performance with respect to standards, guidelines, and options, were identified initially through review of the literature.
Data Synthesis:
Indicators were refined by input from medical directors of Maryland long-term care facilities and subsequent review by expert geriatricians.
Conclusions:
Minimum standards for which 100% performance is expected are communication of advance directives, attention to pain control, and attention to relief of dyspnea. Performance indicators for medical care guidelines and options in terminal care of nursing home patients are also described.
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