Palliative care for long-term care residents: Effect on clinical outcomes

Abstract

Purpose: To determine whether a palliative care (PC) consult service in a long-term care (LTC) facility would result in a more favorable course of treatment and clinical outcomes for participating residents. Design and Methods: We used a historical control design within a single LTC facility. Outcome data and potential confounding variables were obtained using the Minimum Data Set. (Health Care Financing Administration. (1995). Long term care resident assessment instrument user's manual version 2.0. Rockville, MD: Health Care Financing Administration.) Residents who died during the period of the PC service (2007-2009) were compared with matched residents who died in the year prior (2006, historical controls). The analysis sample included 250 residents (125 PC residents, 125 non- PC historical control residents). Our main analysis focused on a composite outcome based on utilization patterns, depression, and pain and other clinical indicators. We analyzed change on this component score (and the individual outcomes) over a 1-year period. Results: PC residents experienced a significant reduction in emergency room (ER) visits (p < .001) and depression (p = .031). Change in the composite score indicated a significant difference over time between the 2 groups (p = .013). Implications: Although limited to 1 facility and drawn from a quasiexperimental design, the results demonstrate the potential for improved quality of care with PC consults. The PC team was effective in reducing ER visits and depression and promoted more appropriate care resulting in more favorable clinical outcomes toward the resident's end of life. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.