Objective: To determine the relationship between an advance care planning (ACP) video intervention, Pragmatic Trial of Video Education in Nursing Homes (PROVEN), and end-of-life health care transitions among long-stay nursing home residents with advanced illness. Design: Pragmatic cluster randomized clinical trial. Five ACP videos were available on tablets or online at intervention facilities. PROVEN champions employed by nursing homes (usually social workers) were directed to offer residents (or their proxies) ≥1 video under certain circumstances. Control facilities employed usual ACP practices. Setting and Participants: PROVEN occurred from February 2016 to May 2019 in 360 nursing homes (119 intervention, 241 control) owned by 2 health care systems. This post hoc study of PROVEN data analyzed long-stay residents ≥65 years who died during the trial who had either advanced dementia or cardiopulmonary disease (advanced illness). We required an observation time ≥90 days before death. The analytic sample included 923 and 1925 advanced illness decedents in intervention and control arms; respectively. Methods: Outcomes included the proportion of residents with 1 or more hospital transfer (ie, hospitalization, emergency department use, or observation stay), multiple (≥3) hospital transfers during the last 90 days of life, and late transitions (ie, hospital transfer during the last 3 days or hospice admission on the last day of life). Results: Hospital transfers in the last 90 days of life among decedents with advanced illness were significantly lower in the intervention vs control arm (proportion difference = −1.7%, 95% CI –3.2%, −0.1%). The proportion of decedents with multiple hospital transfers and late transitions did not differ between the trial arms. Conclusions and Implications: Video-assisted ACP was modestly associated with reduced hospital transfers in the last 90 days of life among nursing home residents with advanced illness. The intervention was not significantly associated with late health care transitions and multiple hospital transfers.
|Original language||English (US)|
|Number of pages||5|
|Journal||Journal of the American Medical Directors Association|
|Early online date||Oct 8 2021|
|State||Published - Mar 2022|
Bibliographical noteFunding Information:
We thank Jessica A. Ogarek for her input on cohort creation early in the project. L.L. reported doing contract work for the American Health Care Association. A.V. has a financial interest in ACP Decisions, a nonprofit organization developing advance care planning video decision support tools. A.V.?s interests were reviewed and are managed by MGH and Mass General Brigham in accordance with their conflict of interest policies. V.M. chairs the Scientific Advisory Board of naviHealth, a health care convener, and is compensated for that role. No other disclosures were reported.
This work was supported by the National Institutes of Health (NIH) Common Fund through a cooperative agreement (5UH3AG49619-03) from the Office of Strategic Coordination/Office of the NIH Director. The views presented here are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.
© 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine
- Advance care planning
- health care transitions
- nursing homes
- pragmatic clinical trial
- Advance Care Planning
- Nursing Homes
- Transition to Adult Care
- Patient Transfer
PubMed: MeSH publication types
- Randomized Controlled Trial
- Journal Article
- Research Support, N.I.H., Extramural