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Correia RH, Dash D, Poss JW, Moser A, Katz PR, Costa AP. Physician Practice in Ontario Nursing Homes: Defining Physician Commitment. J Am Med Dir Assoc 2022; 23:1942-1947.e2. [PMID: 35609638 DOI: 10.1016/j.jamda.2022.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/31/2022] [Accepted: 04/17/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To characterize the practice profile of nursing home (NH) physicians in Ontario, Canada. DESIGN Population-based cross-sectional study. SETTING AND PARTICIPANTS A total of 1527 most responsible physicians (MRPs) across 626 NHs in Ontario, Canada, for the calendar year, 2017. METHODS We examined physician services within all publicly regulated and funded NH facilities. Descriptive summaries were generated to characterize MRPs and their practice patterns by the physician's primary practice location, the NH facility size, and the proportion of physician billings that occurred within NHs. Community sizes were classified into quintiles based on population size and assigned as urban or rural. The number of ministry-designated NH beds were assessed by quintiles to examine physician services by facility size. We also assessed the proportion of physician billings within NHs by quintiles. RESULTS MRPs tended to be older, male, and practice family medicine. The majority of MRPs practiced in communities with populations exceeding 100,000 residents, although physicians with greater NH billings tended to practice in rural locations. The mean number of NH residents that a physician was MRP for was positively associated with the community size. Physicians provided care for more NH residents than they were assigned most responsible. Fifty-one percent of physicians were MRP for 90% of all NH residents. CONCLUSIONS AND IMPLICATIONS Our work provides an exemplar for characterizing physician commitment in NHs, using 2 approaches, according to the NH specialist model. We demonstrated the medical practice characteristics, locations, and billing patterns of physicians within Ontario NHs. Future work can investigate the association between physician commitment and the quality of care provided to NH residents. A greater understanding of physician commitment may lead to the development of quality metrics based on physician practice patterns.
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Affiliation(s)
- Rebecca H Correia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Darly Dash
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey W Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrea Moser
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - Paul R Katz
- Department of Geriatrics, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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Garland A, Keller H, Quail P, Boscart V, Heyer M, Ramsey C, Vucea V, Choi N, Bains I, King S, Oshchepkova T, Kalashnikova T, Kroetsch B, Steer J, Heckman G. BABEL (Better tArgeting, Better outcomes for frail ELderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial. Age Ageing 2022; 51:6552807. [PMID: 35325020 PMCID: PMC8946666 DOI: 10.1093/ageing/afac049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background Nursing home (NH) residents should have the opportunity to consider, discuss and document their healthcare wishes. However, such advance care planning (ACP) is frequently suboptimal. Objective Assess a comprehensive, person-centred ACP approach. Design Unblinded, cluster randomised trial. Setting Fourteen control and 15 intervention NHs in three Canadian provinces, 2018–2020. Subjects 713 residents (442 control, 271 intervention) aged ≥65 years, with elevated mortality risk. Methods The intervention was a structured, \documentclass[12pt]{minimal}
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}{}$\sim$\end{document}60-min discussion between a resident, substitute decision-maker (SDM) and nursing home staff to: (i) confirm SDMs’ identities and role; (ii) prepare SDMs for medical emergencies; (iii) explain residents’ clinical condition and prognosis; (iv) ascertain residents’ preferred philosophy to guide decision-making and (v) identify residents’ preferred options for specific medical emergencies. Control NHs continued their usual ACP processes. Co-primary outcomes were: (a) comprehensiveness of advance care planning, assessed using the Audit of Advance Care Planning, and (b) Comfort Assessment in Dying. Ten secondary outcomes were assessed. P-values were adjusted for all 12 outcomes using the false discovery rate method. Results The intervention resulted in 5.21-fold higher odds of respondents rating ACP comprehensiveness as being better (95% confidence interval [CI] 3.53, 7.61). Comfort in dying did not differ (difference = −0.61; 95% CI −2.2, 1.0). Among the secondary outcomes, antimicrobial use was significantly lower in intervention homes (rate ratio = 0.79, 95% CI 0.66, 0.94). Conclusions Superior comprehensiveness of the BABEL approach to ACP underscores the importance of allowing adequate time to address all important aspects of ACP and may reduce unwanted interventions towards the end of life.
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Affiliation(s)
- Allan Garland
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather Keller
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Patrick Quail
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Veronique Boscart
- School of Health and Life Sciences, Conestoga College, Kitchener, Ontario, Canada
| | - Michelle Heyer
- School of Health and Life Sciences, Conestoga College, Kitchener, Ontario, Canada
| | - Clare Ramsey
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vanessa Vucea
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Nora Choi
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ikdip Bains
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Seema King
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tatiana Oshchepkova
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Brittany Kroetsch
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica Steer
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Barańska I, Kijowska V, Engels Y, Finne-Soveri H, Froggatt K, Gambassi G, Hammar T, Oosterveld-Vlug M, Payne S, Van Den Noortgate N, Smets T, Deliens L, Van den Block L, Szczerbińska K. Factors Associated with Perception of the Quality of Physicians' End-of-life Communication in Long-Term Care Facilities: PACE Cross-Sectional Study. J Am Med Dir Assoc 2019; 21:439.e1-439.e8. [PMID: 31521539 DOI: 10.1016/j.jamda.2019.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/17/2019] [Accepted: 07/20/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine factors associated with perceived quality of communication with physicians by relatives of dying residents of long-term care facilities (LTCFs). DESIGN A cross-sectional retrospective study in a representative sample of LTCFs conducted in 2015. In each LTCF, deaths of residents during the 3 months before the researcher's visit were reported. Structured questionnaires were sent to the identified relatives of deceased residents. SETTINGS AND PARTICIPANTS A total of 736 relatives of deceased residents in 210 LTCFs (in Belgium, Finland, Italy, the Netherlands, and Poland). METHODS The Family Perception of Physician-Family Communication scale (FPPFC) was used to assess the quality of end-of-life (EOL) communication with physicians as perceived by relatives. We applied multilevel linear regression models to find factors associated with the FPPFC score. RESULTS The quality of EOL communication with physicians was perceived by relatives as higher when the relative spent more than 14 hours with the resident in the last week of the resident's life (b = 0.205; P = .044), and when the treating physician visited the resident at least 3 times in the last week of the resident's life (b = 0.286; P = .002) or provided the resident with palliative care (b = 0.223; P = .003). Relatives with higher emotional burden perceived the quality of EOL communication with physicians as lower (b = -0.060; P < .001). These results had been adjusted to countries and LTCF types with physicians employed on-site or off-site of the facility. CONCLUSION The quality of EOL communication with physicians, as perceived by relatives of dying LTCF residents, is associated with the number of physician visits and amount of time spent by the relative with the resident in the last week of the resident's life, and relatives' emotional burden. IMPLICATIONS LTCF managers should organize care for dying residents in a way that enables frequent interactions between physicians and relatives, and emotional support to relatives to improve their satisfaction with EOL communication.
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Affiliation(s)
- Ilona Barańska
- Unit for Research on Aging Society, Department of Sociology, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Violetta Kijowska
- Unit for Research on Aging Society, Department of Sociology, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Giovanni Gambassi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Teija Hammar
- National Institute for Health and Welfare, Helsinki, Finland
| | - Mariska Oosterveld-Vlug
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Sheila Payne
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Tinne Smets
- Department of Family Medicine and Chronic Care, End-of- Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Luc Deliens
- Department of Family Medicine and Chronic Care, End-of- Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, End-of- Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Katarzyna Szczerbińska
- Unit for Research on Aging Society, Department of Sociology, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
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