Recent Research Suggests SNFists Play Vital Role in End-of-Life Care

Nursing home residents at the end of life (EOL) often face challenging transitions indicative of substandard care, which can disrupt their lives and lead to lower quality of life. A recent investigational study published in JAMA Network Open explores how skilled nursing facilities (SNFs) and introducing SNFists may improve the quality of EOL care nursing home residents.

According to the study, "During the past 2 decades, the proportion of clinicians (ie, physicians, nurse practitioners, and physician assistants) who practice primarily in [nursing homes] or [SNFs], frequently termed SNFists (ie, physicians, nurse practitioners, and physician assistants concentrating their practice in the [nursing home] or SNF setting, has increased at a rapid pace."

While this specialization might offer benefits in better understanding the complex needs of nursing home residents, it's still being determined whether it improves EOL care quality or exacerbates care fragmentation.

Researchers used Medicare claims data to identify the cohort study population, which included nursing home residents aged 65 and older who had been long-stay residents. After reviewing the data and referencing other studies, researchers defined what they consider "burdensome transitions" as a hospital transfer during the last 3 days of life, a lack of continuity in nursing homes after hospitalization, multiple hospitalizations, and any hospitalization for an ambulatory care-sensitive condition (aligning with the definition from the Agency for Healthcare and Research Quality). All of which were used as outcomes.

"In this national cohort study of [nursing home] decedents, we found that receipt of care from SNFists was associated with a reduced likelihood of experiencing 3 of 4 types of burdensome transitions, suggesting that these clinicians may play an important role in improving the EOL care for this population," said researchers.

Researchers later clarified that while these outcomes appear positive, more research is needed to better characterize which SNFists provide holistic care across a wider domain. The outcomes also emphasize the need to increase the use of SNFists.

Reference

Ghosh AK, Unruh MA, Yun H, Jung H. Clinicians who practice primarily in nursing homes and the quality of end-of-life care among residents. JAMA Netw Open. 2024;7(3):e242546. doi:10.1001/jamanetworkopen.2024.2546