Nursing home (NH) residents with advanced illness not only often receive unnecessary antimicrobials, they also frequently get transferred to acute care hospitals with suspected infections; these treatments are usually burdensome and inconsistent with palliative care goals. In 2017 as part of our successful parent study, “Study of Infection Management and Palliative Care at End-of-Life” (R01 NR13687) we surveyed a national stratified random sample of NHs (n = 892) to identify best practices in 1) infection prevention and control, 2) infection management, 3) palliative care, and 4) integration of infection management and palliative care (i.e, integration); the latter which we defined as when preferences for antibiotics and hospitalization due to infections are assessed and followed. We identified 3 psychometrically-sound integration measures with the highest level of integration for resident or resident proxy “Involvement” in care planning and lower rates for “Advance Care Planning” and “Routine Practices”. Using longitudinal Minimum Data Set (MDS) 3.0 data, Medicare claims, and our 2014 survey of NHs (n = 992) we found increased reporting of comprehensive antibiotic stewardship programs; however, we also found no reduction in the use of antibiotics in NHs. Suspected infection continue to be a common reason for NH resident transfers to the hospital. We still do not know how best to support NHs to improve the quality of end-of-life care and support the integration of infection management and palliative care in residents with advanced illness.
