Impact of an Advance Care Planning Video Intervention on Care of Short-Stay Nursing Home Patients

Lacey Loomer, Jessica A. Ogarek, Susan L. Mitchell, Angelo E. Volandes, Roee Gutman, Pedro L. Gozalo, Ellen M. McCreedy, Vincent Mor

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND/OBJECTIVES: To assess whether an advance care planning (ACP) video intervention impacts care among short-stay nursing home (NH) patients. DESIGN: PRagmatic trial of Video Education in Nursing Homes (PROVEN) was a pragmatic cluster randomized clinical trial. SETTING: A total of 360 NHs (N = 119 intervention, N = 241 control) owned by two healthcare systems. PARTICIPANTS: A total of 2,538 and 5,290 short-stay patients with advanced dementia or cardiopulmonary disease (advanced illness) in the intervention and control arms, respectively; 23,302 and 50,815 short-stay patients without advanced illness in the intervention and control arms, respectively. INTERVENTION: Five ACP videos were available on tablets or online. Designated champions at each intervention facility were instructed to offer a video to patients (or proxies) on admission. Control facilities used usual ACP practices. MEASUREMENTS: Follow-up time was at most 100 days for each patient. Outcomes included hospital transfers per 1000 person-days alive and the proportion of patients experiencing more than one hospital transfer, more than one burdensome treatment (tube-feeding, parenteral therapy, invasive mechanical intervention, and intensive care unit admission), and hospice enrollment. Champions recorded whether a video was offered in the patients' electronic medical record. RESULTS: There was no significant reduction in hospital transfers per 1000 person-days alive in the intervention versus control groups with advanced illness (rate (95% confidence interval (CI)), 12.3 (11.6–13.1) vs 13.2 (12.5–13.7); rate difference: −0.8; 95% CI = −1.8–0.2)). There was a nonsignificant reduction in hospital transfers per 1000 person-days alive in the intervention versus control among short-stay patients without advanced illness. Secondary outcomes did not differ between groups among patients with and without advanced illness. Based on champion only reports 14.2% and 15.3% of eligible short-stay patients with and without advanced illness were shown videos, respectively. CONCLUSION: An ACP video program did not significantly reduce hospital transfers, burdensome treatment, or hospice enrollment among short-stay NH patients; however, fidelity to the intervention was low.

Original languageEnglish (US)
Pages (from-to)735-743
Number of pages9
JournalJournal of the American Geriatrics Society
Volume69
Issue number3
DOIs
StatePublished - Mar 2021
Externally publishedYes

Bibliographical note

Funding Information:
This work is supported within the National Institutes of Health (NIH) Health Care Systems Research Collaboratory by the NIH Common Fund through cooperative agreement U24AT009676 from the Office of Strategic Coordination within the Office of the NIH Director and cooperative agreement UH3AG049619 from the National Institute on Aging (NIA). Dr Mitchell is supported by the NIA under award number K24AG033640. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Mor chairs the Scientific Advisory Committee for naviHealth, a postacute care convener serving hospitals and Medicare advantage plans, a role for which he is compensated. Dr Loomer was previously a consultant for the American Health Care Association. Dr Gutman reports consulting for Johnson & Johnson/Janssen. Drs Mitchell, Mor, Volandes, and Gutman had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analyses. Study concept and design: Loomer, Ogarek, Mitchell, Mor, Volandes, and Gutman. Acquisition of data: Mitchell, Mor, and Volandes. Analyses and interpretation of data: Mitchell, Mor, Volandes, Gutman, Gozalo, McCreedy, Ogarek, and Loomer. Drafting of manuscript: Loomer. Critical revision of manuscript for important intellectual content: Mitchell, Mor, Volandes, Gutman, Gozalo, McCreedy, Ogarek, and Loomer. Statistical analyses: Mor, Gutman, Gozalo, and Ogarek. Administrative, technical, or material support: Mitchell, Mor, and Volandes. Study supervision: Mitchell, Mor, and Volandes The funding sources for this study played no role in the design or conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Funding Information:
This work is supported within the National Institutes of Health (NIH) Health Care Systems Research Collaboratory by the NIH Common Fund through cooperative agreement U24AT009676 from the Office of Strategic Coordination within the Office of the NIH Director and cooperative agreement UH3AG049619 from the National Institute on Aging (NIA). Dr Mitchell is supported by the NIA under award number K24AG033640. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2021 The American Geriatrics Society

Keywords

  • Medicare
  • advance care planning
  • nursing homes
  • pragmatic clinical trial

PubMed: MeSH publication types

  • Journal Article

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