The mean age of the CI subjects was 83, and 83% were women. The mean Mini-Mental State Exam score was 15.7. One-third of the CI subjects were unable to complete any of the three pain assessment tools. Of the 104 subjects completing at least one tool, 13 (12.5%) reported no pain and 91 (87.5%) reported some pain. Sixteen (10%) of the subjects were depressed as measured with the GDS or Cornell instrument. In 70 of the 104 subjects (67%) able to complete any tool, the caregiver and CI subject agreed as to the level of pain experienced by the CI subject. The number of tools completed by the CI subjects decreased with increased cognitive impairment. The Pain Intensity Scale was the tool most likely to be completed by both CI subjects and caregivers. The means of test scores were not significantly different for the paired groups of CI subject and caregiver, and the nonparametric correlation of each tool was significant: "faces" (Spearman's rho (p) = .417); "line" (p = .420); and PIS (p = .452). The Hospice Approach Discomfort Scale did not correlate well with other tools. The Pain Intensity Scale seems to be more useful than other pain assessment tools in assessing pain in cognitively impaired patients and can be used by nonprofessional caregivers in a community-based care setting.

To enhance end-of-life care in a community hospital system, an interdisciplinary team designed and implemented a mail survey to obtain feedback from families of inpatients who died. The 855 completed surveys (a 31% response rate) demonstrate that bereaved families are willing to give feedback on care received from nurses and physicians and attention paid to the personal needs of patients and families. The team used families' feedback to shape quality improvement initiatives and focused on questions with comparatively lower scores: physician communication, physician compassion, and family understanding of what to expect as their loved one approached the end of life.

Asthma is one of the most common chronic diseases. The prevalence of asthma appears to be increasing. National data have suggested that Oregon's asthma mortality rate has been twice as high as the national average. The prevalence and impact of asthma are not systematically assessed or tracked within Oregon. We estimated the current asthma prevalence and mortality using data from statewide hospital discharge data, the 1995 Behavioral Risk Factor Surveillance Survey, and school registration data from the Portland area. A conservative estimate of Oregon's current asthma prevalence is 6-7% and lifetime asthma prevalence is estimated at 6-11% for both adults and children. It appears that current asthma prevalence increases during adolescence. The Willamette Valley, an area known for high pollen counts, does not have a higher rate of hospital discharges per capita than other areas within the state. Oregon's apparent higher asthma mortality may be the result of the Oregon State Health Division's aggressive policies toward accurate reporting on death certificates. Oregon's age distribution may also contribute to the apparent higher asthma mortality rate.