TY - JOUR
T1 - Effect of a Video-Assisted Advance Care Planning Intervention on End-of-Life Health Care Transitions Among Long-Stay Nursing Home Residents
AU - Moyo, Patience
AU - Loomer, Lacey
AU - Teno, Joan M.
AU - Gutman, Roee
AU - McCreedy, Ellen M.
AU - Bélanger, Emmanuelle
AU - Volandes, Angelo E.
AU - Mitchell, Susan L.
AU - Mor, Vincent
N1 - Publisher Copyright:
© 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - Advance care planning
KW - end-of-life
KW - health care transitions
KW - nursing homes
KW - pragmatic clinical trial
UR - http://www.scopus.com/inward/record.url?scp=85116900307&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85116900307&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2021.09.014
DO - 10.1016/j.jamda.2021.09.014
M3 - Article
C2 - 34627753
AN - SCOPUS:85116900307
SN - 1525-8610
VL - 23
SP - 394
EP - 398
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 3
ER -