Clinicians who work at skilled nursing facilities and nursing homes can be crucial to improve the quality of end-of-life care for residents, according to a new study.
During the past two decades, the number of physicians, nurse practitioners and physician assistants who practice mostly in the facilities (often called SNFists) has risen. But researchers weren’t sure if using them improves a better quality of care for people at the end of their lives, according to the study published on March 15 in JAMA Network Open.
Researchers examined data on nearly 2.1 million people living in nursing homes. This included 953,722 residents who received care from the clinicians and 1,138,323 residents who were treated by other providers. The clinicians in the study had to spend at least 80% of their time practicing in a long-term care facility to be included. Medicare claims evaluated were from 2013 to 2019.
Residents who received care from clinicians at skilled nursing facilities had a lower risk of troublesome transitions at the end of life (within the last 90 days of life). Those types of transitions included being moved to a hospital in the last three days of their lives; being transferred from a nursing home to hospital, and then back to another nursing home; multiple hospitalizations for any reason; and any hospitalization for an ambulatory care-sensitive condition.
What makes care from an SNFist better compared to other clinicians not spending the majority of their time at the facility? The authors pointed to other studies that have shown the clinicians working at the facilities have lower rehospitalization rates, less long-term use of antipsychotics and less catheter use. The patients may have better outcomes because clinicians may be more familiar with patients’ medical history and have better communication with staff, patients and family members, the authors wrote.
Difficult end-of-life transitions can be reduced with care from skilled nursing facility clinicians, the authors added.
