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Acute care practices relevant to quality end-of-life care: a survey of Pennsylvania hospitals
  1. C Y Lin1,2,
  2. R M Arnold1,2,
  3. J R Lave1,3,
  4. D C Angus1,4,
  5. A E Barnato1,2,3
  1. 1Center for Research on Health Care, Pittsburgh, Pennsylvania, USA
  2. 2University of Pittsburgh School of Medicine, Department of Medicine, Pittsburgh, Pennsylvania, USA
  3. 3Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  4. 4Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Amber Barnato, Center for Research on Health Care and the Institute for Clinical Research Education, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Suite 200, Pittsburgh, PA 15213, USA; barnatoae{at}


Background Improving end-of-life care in the hospital is a national priority.

Purpose To explore the prevalence and reasons for implementation of hospital-wide and intensive care unit (ICU) practices relevant to quality care in key end-of-life care domains and to discern major structural determinants of practice implementation.

Design Cross-sectional mixed-mode survey of chief nursing officers of Pennsylvania acute care hospitals.

Results The response rate was 74% (129 of 174). The prevalence of hospital and ICU practices ranged from 95% for a hospital-wide formal code policy to 6% for regularly scheduled family meetings with an attending physician in the ICU. Most practices had less than 50% implementation; most were implemented primarily for quality improvement or to keep up with the standard of care. In a multivariable model including hospital structural characteristics, only hospital size independently predicted the presence of one or more hospital initiatives (ethics consult service, OR 6.13, adjusted p=0.02; private conference room in the ICU for family meetings, OR 4.54, adjusted p<0.001).

Conclusions There is low penetration of hospital practices relevant to quality end-of-life care in Pennsylvania acute care hospitals. Our results may serve to inform the development of future benchmark goals. It is critical to establish a strong evidence base for the practices most associated with improved end-of-life care outcomes and to develop quality measures for end-of-life care to complement existing hospital quality measures that primarily focus on life extension.

  • Terminal care
  • intensive care unit
  • intensive care
  • critical care
  • quality improvement
  • quality of care
  • culture
  • clinical practice guidelines
  • research
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  • Funding This work was funded by a research grant awarded to AEB (US National Institutes of Health grant K08 AG021921).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Pittsburgh.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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