Chartbook on Healthy Living

Goals of Supportive and Palliative Care

• Disease cannot always be cured, and functional impairment cannot always be reversed.
• For patients with long-term health conditions, managing symptoms and preventing complications are important goals.
• Supportive and palliative care:
  • Cuts across many medical conditions.
  • Is delivered by many health care providers.
  • Focuses on enhancing patient comfort and quality of life and preventing and relieving symptoms and complications.

Measures of Supportive and Palliative Care

• Improvement in shortness of breath among home health care patients.
• Nursing home residents with moderate to severe pain.
• Nursing home residents who lost too much weight.

Shortness of Breath Among Home Health Care Patients

• Shortness of breath is uncomfortable.
• Many patients with heart or lung problems experience difficulty breathing and may tire easily or be unable to perform daily activities.
• Doctors and home health staff should monitor shortness of breath and may give advice, therapy, medication, or oxygen to help lessen this symptom.

Adult home health care patients whose episodes of shortness of breath decreased, by age and race/ethnicity, 2010-2013

Left Chart:

Right Chart:

2010 Achievable Benchmark: 70.7%.

Source: Centers for Medicare & Medicaid Services, Outcome and Assessment Information Set (OASIS), 2010-2013.
Denominator: Adult nonmaternity patients completing an episode of skilled home health care.
Note: White and Black are non-Hispanic. Hispanic includes all races. Starting January 1, 2010, the patient assessment instrument for home health agencies was changed to OASIS-C.

• Importance: Shortness of breath interferes with activity and is an important health status indicator. It affects quality of life, ability to engage in a wide variety of activities, and patients’ ability to care for themselves.
• Overall Rate: In 2013, 65% of home health care patients had less shortness of breath.
• Trend: From 2010 to 2013, the percentage of adult home health care patients whose episodes of shortness of breath decreased improved overall and for Blacks and Whites.
• Groups With Disparities:
  • In all years, Hispanics were less likely than Whites to show improvement in shortness of breath. From 2010 to 2013, there was no statistically significant change in this disparity.   
• Achievable Benchmark:
  • The 2010 top 5 State achievable benchmark was 70.7%. The top 5 States that contributed to the achievable benchmark are District of Columbia, Hawaii, Maryland, New Jersey, and South Carolina.
  • At the current rate, the overall rate could reach the benchmark in 6 years. All ages and racial/ethnic groups could reach the benchmark within 10 years except Hispanics, who show no progress toward the benchmark.

Moderate to Severe Pain Among Nursing Home Residents

• Pain management is a particularly important clinical concern for older adults residing in nursing homes.
• Poorly managed pain can decrease resident quality of life, reduce mobility and functional status, and increase loneliness and depression.¹

Long-stay nursing home residents who have moderate to severe pain, by race and age, 2012-2013

Left Chart:

Right Chart:

2010 Achievable Benchmark: 7.1%.

Key: NHOPI = Native Hawaiian or Other Pacific Islander; AI/AN = American Indian or Alaska Native.
Source: Centers for Medicare & Medicaid Services, Minimum Data Set, 2012-2013. Data are from the third quarter of the calendar year.
Denominator: All long-stay residents in Medicare- or Medicaid-certified nursing home facilities.
Note: For this measure, lower rates are better.

• Importance: Failure to identify the presence of pain or to assess its severity and functional impact can leave a potentially treatable symptom unrecognized and therefore unlikely to be addressed.
• Overall Rate: In 2013, 10.0% of nursing home residents had moderate to severe pain.
• Groups With Disparities:
  • In 2012 and 2013, Blacks, Asians, Native Hawaiians and Other Pacific Islanders, and multiple-race residents were less likely than Whites to have moderate to severe pain.
  • In both years, American Indians and Alaska Natives were more likely than Whites to have moderate to severe pain.
  • In both years, residents ages 0-64, 65-74, and 75-84 were more likely than residents age 85 and over to have moderate to severe pain.
• Achievable Benchmark:
  • The 2011 top 5 State achievable benchmark was 7.1%. The top 5 States that contributed to the achievable benchmark are District of Columbia, Hawaii, Maryland, New Jersey, and New York.
  • Asians and multiple-race residents have achieved the benchmark.

Weight Loss Among Nursing Home Residents

• Unintentional weight loss is a common problem among nursing home residents.
• Weight loss is associated with adverse, costly clinical outcomes, including increased hospitalization, morbidity, and mortality.
• The Minimum Data Set defines clinically significant weight loss for nursing home residents:
  • Weight loss ≥5% within a 30-day period or 10% within a 180-day period.

Long-stay nursing home residents who lost too much weight, by age and race/ethnicity, 2011-2013

Left Chart:

Right Chart:

2011 Achievable Benchmark: 7.4 %.

Source: Centers for Medicare & Medicaid Services, Minimum Data Set, 2011-2013.
Note: White and Black are non-Hispanic. Hispanic includes all races.

• Importance: Nursing home residents with weight loss are at higher risk for functional decline, hip fracture, and death. Weight loss also may lead to muscle wasting, infections, and increased risk of pressure ulcers. Detecting and preventing weight loss is central to ensure appropriate nutritional intake.
• Overall Rate: The percentage of long-stay nursing home residents who lost too much weight was 9.2% in 2013.
• Groups With Disparities:
  • From 2011 to 2013, the percentage of nursing home residents who lost too much weight was higher for people ages 65-74, 75-84, and 85 and over compared with those under age 64.
  • In all years, the percentage of nursing home residents who lost too much weight was lower for Black and Hispanic residents compared with White residents. 
• Achievable Benchmark:
  • The 2011 top 6 State achievable benchmark was 7.4%. The top 6 States that contributed to the achievable benchmark are California, District of Columbia, Maryland, Massachusetts, New York, and Texas.
  • Only nursing home residents ages 0-64 and Hispanics have achieved the benchmark.

References

1. Abrahamson K, DeCrane S, Mueller C, et al. Implementation of a nursing home quality improvement project to reduce resident pain: a qualitative case study. J Nurs Care Qual 2015 Jul-Sep;30(3):261-8. PMID: 25407787.

Return to Contents