Home Medizin SNFisten verbessern die Qualität der Pflege am Lebensende von Pflegeheimbewohnern

SNFisten verbessern die Qualität der Pflege am Lebensende von Pflegeheimbewohnern

von NFI Redaktion

Researchers from Weill Cornell Medicine have found that specialized skilled nursing facility physicians or SNFists can reduce the likelihood of nursing home residents experiencing stressful hospital stays and improve quality of life in their final days.

Published on March 15th in JAMA Network Open paper, the study examined how SNF members uniquely impacted the care of nursing home residents in the last 90 days compared to those cared for by other clinicians. This large-scale study is the first of its kind.

The literature has described certain characteristics or outcomes that we believe lead to poor end-of-life quality. An example is the transfer of residents to hospitals and their admission for conditions like pneumonia or urinary tract infections, which may have been treatable in the nursing home, or the transfer of residents from one nursing home to another.

Dr. Arnab Ghosh, Assistant Professor of Medicine at Weill Cornell Medicine and Hospitalist at NewYork-Presbyterian/Weill Cornell Medical Center

The physical act of moving residents to a new environment increases their risk of delirium and discomfort, the researchers said. Transfers also disrupt communication and continuity of care, burden patients, and make them more uncomfortable.

In the study, SNFists were defined as medical professionals (doctors, nurses, and physician assistants) who conducted at least 80 percent of their patient visits in the nursing home setting. They found that this specialization gave SNFists a deeper insight into the clinical conditions of nursing home residents, enabling better communication between residents, their families, and other staff.

The study of 2,091,954 nursing home residents aged 65 and older from January 2012 to December 2019 found that SNFists managed about 46 percent of this group. The researchers found that care by an SNFist reduced the risk of hospitalizations for any reason, including pneumonia, urinary tract infection, dehydration, or sepsis, by up to 6 percent.

The need for SNF professionals will only increase as the U.S. population ages and more people develop dementia. Two-thirds of all Alzheimer’s-related deaths occur in nursing homes. Other professions may also need to be bolstered. „We need more research to compare the quality of care among different nursing home physicians, including doctors, nurses, and physician assistants, but we are clearly seeing fewer doctors working in nursing homes while NPs and PAs are increasing,“ said Dr. Hye-Young Jung, Associate Professor of Population Health Sciences at Weill Cornell Medicine.

The researchers suggest that medical schools and residency programs may need to offer more experiences in nursing home care to increase the number of physicians in this field. They also emphasize the need to designate an official specialization, as in other areas of medicine like hospitalists, that would allow for certification of the unique knowledge and skills required in the nursing home setting.

Source:

Journal Reference:

Ghosh, AK, et al. (2024). Physicians primarily practicing in nursing homes and the quality of end of life care for residents. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2024.2546.

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