Specialized SNF Clinicians Can Help Improve Care Quality at End of Life

Specialized nursing facility clinicians, or SNFists, have a strong potential to reduce hospitalizations and improve quality of care at the end of life, including access to hospice.

The work of SNFists uniquely impacted the care of nursing home residents during their last 90 days of life, according to a study published in JAMA Network Open.

Terminally ill nursing home residents often undergo burdensome experience burdensome transitions of care that adversely affect quality. Some of the issues that frequently occur include increased risk of feeding tube use, intensive care unit stays, late enrollment in hospice and receipt of care that is not concordant with the resident’s wishes, the study indicated.


“The literature has described certain features or outcomes that translate into what we think is poor quality at the end of life,” said Dr. Arnab Ghosh, assistant professor of medicine at Weill Cornell Medicine and a hospitalist at NewYork-Presbyterian/Weill Cornell Medical Center, in a statement. “One example is transferring residents to the hospital and admitting them for conditions like pneumonia or UTIs (urinary tract infections) that may have been managed in the nursing home, or going from nursing home to hospital to another nursing home.”

Researchers defined “SNFists” as physicians, nurse practitioners and physician assistants who provided at least 80% of their patient visits in the nursing home setting. They indicated in the study that this degree of specialization gives these professionals “deeper insight” into the clinical conditions that affect nursing home residents. This allows for better communication between the residents, their families and other staff members, the study found.

The study examined medical records of nearly 2.1 million nursing home residents aged 65 and older, between January 2012 and December 2019. Among those, SNFists managed the care of nearly 46%.


SNFists decreased the risk of hospitalization for any reason by 6%, including for instances of pneumonia, urinary tract infection, dehydration or sepsis.

The physical act of transferring the residents to new environments increases their risk of delirium and discomfort, the researchers said. Transfers also interrupt communication and continuity of care, burdening patients and making them more uncomfortable.

More studies are necessary to accrue more comparative data on the impact that different types of clinicians have on hospitalizations and quality of care at the end of life, according to Dr. Hye-Young Jung, associate professor of population health sciences at Weill Cornell Medicine.

“We need more research comparing the quality of care from different nursing home clinicians including medical doctors, nurse practitioners and physician assistants, but we clearly see fewer MDs working in nursing homes while NPs and PAs are increasing,” Jung said.

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