According to background information in the article, the majority of deaths in industrialized countries occur in health care institutions. "With recent changes in health care, society is struggling with the role that governmental and nongovernmental regulatory structures should play in assuring that the health care system provides competent, coordinated, and compassionate care at life's end," the authors write.
Joan M. Teno, M.D., M.S., from Brown Medical School, Providence, R.I., and colleagues reviewed data provided by family members, or others who had been close to the patient, representing 1,578 people who died. This information from a probability sample of individuals who died in the U.S. in 2000 was used to estimate end-of-life care outcomes for 1.97 million deaths from chronic illness. The respondents were asked about the quality of care at the last place the patient spent at least 48 hours.
"For the majority (68.9 percent), the last place of care was an institutional setting, either a hospital or nursing home," the authors report in their findings. "Home was the last place of care for 31.1 percent; of those, 36.1 percent died without any nursing services, 12.4 percent had home nursing services, and 51.5 percent had home hospice services." The authors write that family perceptions of quality of care differed by the last place of care for the patient. "Nearly one-fourth of all respondents reported that the patient did not receive any or enough help with pain (24.2 percent) or dyspnea [difficulty breathing] (22.4 percent). Family members of persons whose last place of care was a nursing home or home with home health nursing services had a higher rate of
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