INDICATORS OF QUALITY MEDICAL-CARE FOR THE TERMINALLY ILL IN NURSING-HOMES

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; in put from nursing home medical directors in Maryland; and input from ex pert geriatricians. STUDY SELECTION: More than 900 articles, books, an d abstracts from meetings covering medical care for terminally ill pat ients were reviewed. Information from more than 100 publications is in cluded. DATA EXTRACTION: Indicators of medical care for terminally ill patients, which can be used to quantify performance with respect to s tandards, guidelines, and options, were identified initially through r eview of the literature. DATA SYNTHESIS: Indicators were refined by in put from medical directors of Maryland long-term care facilities and s ubsequent review by expert geriatricians.CONCLUSIONS: Minimum standard s for which 100% performance is expected are communication of advance directives, attention to pain control, and attention to relief of dysp nea. Performance indicators for medical care guidelines and options in terminal care of nursing home patients are also described.