Improving End-of-Life Outcomes in Nursing Homes by Targeting Residents at High Risk of Mortality for Palliative Care: Program Description and Evaluation

ABSTRACT Objectives: The objectives were (1) to describe the Making Advance Planning a Priority (MAPP) program, a program designed to identify nursing home (NH) residents at high risk of death and (2) to evaluate end-of-life care outcomes for NH residents at high risk of death. Design: Program description and evaluation using a retrospective chart review before and after implementation of the MAPP program. Participants: NH residents who died 1 year before program implementation compared to NH residents who died 1 year after program implementation (n = 72). Program description: The MAPP program was designed to: (1) identify residents at high risk of death, (2) inform the attending physician of the residents' mortality risk, (3) obtain palliative care or, if the prognosis was 6 months of less, a hospice consultation, and (4) improve advance care planning documentation. Program evaluation: Site of death (hospital versus nursing home), presence of an advance directive, presence of an order for cardiopulmonary...