Effect of advance care planning video on do-not-hospitalize orders for nursing home residents with advanced illness

BMC Geriatrics

卷:22

Xiaofei Yang¹  Pedro L. Gozalo¹  Ellen M. McCreedy¹  Patience Moyo¹  Emmanuelle Belanger¹  Jessica Ogarek¹  Vincent Mor¹  Roee Gutman²  Lacey Loomer³  Susan L. Mitchell⁴  Joan Teno⁵  Angelo Volandes⁶ 

[1] Center for Gerontology and Healthcare Research, Brown University School of Public Health;

[2] Department of Biostatistics, Brown University School of Public Health;

[3] Department of Economics and Health Care Management, Labovitz School of Business and Economics, University of Minnesota Duluth;

[4] Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife;

[5] Oregon Health Sciences University School of Medicine;

[6] Section of General Medicine, Massachusetts General Hospital;

关键词: Pragmatic trial;    Nursing home;    Dementia;    Advance care planning;   

DOI  :  10.1186/s12877-022-02970-3

来源: DOAJ

【 摘 要 】

Abstract Background The purpose of the study is to evaluate the effect of an Advance Care Planning (ACP) Video Program on documented Do-Not-Hospitalize (DNH) orders among nursing home (NH) residents with advanced illness. Methods Secondary analysis on a subset of NHs enrolled in a cluster-randomized controlled trial (41 NHs in treatment arm implemented the ACP Video Program: 69 NHs in control arm employed usual ACP practices). Participants included long (> 100 days) and short (≤ 100 days) stay residents with advanced illness (advanced dementia or cardiopulmonary disease (chronic obstructive pulmonary disease or congestive heart failure)) in NHs from March 1, 2016 to May 31, 2018 without a documented Do-Not-Hospitalize (DNH) order at baseline. Logistic regression with covariate adjustments was used to estimate the impact of the resident being in a treatment versus control NH on: the proportion of residents with new DNH orders during follow-up; and the proportion of residents with any hospitalization during follow-up. Clustering at the facility-level was addressed using hierarchical models. Results The cohort included 6,117 residents with advanced illness (mean age (SD) = 82.8 (8.4) years, 65% female). Among long-stay residents (n = 3,902), 9.3% (SE, 2.2; 95% CI 5.0–13.6) and 4.2% (SE, 1.1; 95% CI 2.1–6.3) acquired a new DNH order in the treatment and control arms, respectively (average marginal effect, (AME) 5.0; SE, 2.4; 95% CI, 0.3–9.8). Among short-stay residents with advanced illness (n = 2,215), 8.0% (SE, 1.6; 95% CI 4.6–11.3) and 3.5% (SE 1.0; 95% CI 1.5–5.5) acquired a new DNH order in the treatment and control arms, respectively (AME 4.4; SE, 2.0; 95% CI, 0.5–8.3). Proportion of residents with any hospitalizations did not differ between arms in either cohort. Conclusions Compared to usual care, an ACP Video Program intervention increased documented DNH orders among NH residents with advanced disease but did not significantly reduce hospitalizations. Trial registration. ClinicalTrials.gov Identifier: NCT02612688 .

【 授权许可】

Unknown