The Association between Multiple Chronic Conditions, Domains of End-of-Life Care Quality, Care Coordination, and the Perception of High Quality End-of-Life Care for Older Adults
出版項
2017
說明
1 online resource (221 pages)
文字
text
無媒介
computer
成冊
online resource
附註
Source: Dissertation Abstracts International, Volume: 78-10(E), Section: B
Adviser: Neil Jordan
Thesis (Ph.D.)--Northwestern University, 2017
Includes bibliographical references
While literature indicates that fewer than half of older adults aged 65 years or older receive high quality end-of-life care, less is known about the quality of end-of-life care experienced by the segment of that population with multiple chronic conditions (MCC). Drawing upon the Teno Model of high quality end-of-life care, the goals of this study were to advance the understanding of the quality of end-of-life care experienced by older adults with MCC and how that care may be improved. Three specific aims addressed the study's goals: (1) to identify disparities in end-of-life care quality by MCC status; (2) to determine which dimensions of end-of-life care quality were associated with high quality end-of-life care for older adults with MCC; and (3) to assess the association between care coordination and high quality end-of-life care for older adults with MCC. This retrospective cross-sectional cohort study utilized the nationally representative National Health and Aging Trends Study (NHATS), Last Month of Life Interview (LMLI). Results indicated that end-of-life care quality does not differ significantly by MCC status, but meaningful gaps in care exist for all older adults, particularly relating to spiritual and emotional support. We also identified that dying at home was significantly associated with higher rates of hospice enrollment, better ratings of overall end-of-life care quality, and a "positive" perception of care for several quality dimensions for the general older adult population and for older adults with MCC. In this study, ratings of overall end-of-life care quality for older adults with MCC were associated with their experience in the coordination, shared decision-making, respect, and spiritual and emotional support domains, but not their experience with symptom management. Findings also suggested that older adults with MCC who do not have cancer may experience different benefits from hospice, Medicare's primary end-of-life care program and the gold standard for end-of-life care quality, than dying older adults with MCC that does not include cancer. Study findings identified care coordination as an end-of-life care improvement approach worth further investigation. Additionally, this study confirmed the need to improve end-of-life care quality research approaches, which currently limit the ability to improve end-of-life care quality meaningfully
Electronic reproduction. Ann Arbor, Mich. : ProQuest, 2017
