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J Am Med Dir Assoc. 2019 Mar 6. pii: S1525-8610(19)30160-4. doi: 10.1016/j.jamda.2019.01.133. [Epub ahead of print]

Nursing Home Characteristics Associated With Implementation of an Advance Care Planning Video Intervention.

Author information

1
Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI. Electronic address: lacey_loomer@brown.edu.
2
Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI.
3
Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI.
4
Hebrew Senior Life, Institute for Aging Research, Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
5
Section of General Medicine, Massachusetts General Hospital, Boston, MA.
6
Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI; Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI; Center of Innovation in HSR&D, Providence Veterans Administration Medical Center, Providence, RI.

Abstract

OBJECTIVES:

Advance care planning (ACP) is important to ensure that nursing home (NH) residents receive care concordant with their goals. Video interventions have been developed to improve the process of ACP. Yet, little is known about which NH characteristics are associated with implementation of ACP video interventions in clinical practice. Our objective was to examine NH-level characteristics associated with the implementation of an ACP video intervention as part of the Pragmatic trial of Video Education in Nursing Homes (PROVEN) trial.

DESIGN:

Cross-sectional study of NHs in PROVEN.

SETTING AND PARTICIPANTS:

119 NHs randomized to receive the ACP video intervention.

MEASUREMENTS:

The outcomes were the proportion of short- (<100 days) and long-stay (≥100 days) NH residents who were (1) offered to watch a video and (2) shown a video, aggregated to the NH-level, and measured using electronic forms of video offers. The association between outcomes and NH facility characteristics (eg, staffing, resident acuity) and participation in other aspects of the PROVEN trial (eg, monthly check-in calls) were estimated using multivariate linear regression models. NH characteristics were measured using data from Online Survey Certification and Reporting data, Long-term Care: Facts on Care in the US and NH Compare.

RESULTS:

Offer rates were 69% [standard deviation (SD): 28] for short-stay and 56% (SD: 20) for long-stay residents. Show rates were 19% (SD: 21) for short-stay and 17% (SD: 17) for long-stay residents. After adjusting for NH characteristics, compared to 1-star NHs, higher star-rated NHs had higher offer rates. Champions' participation in check-in calls was positively associated with both outcomes for long-stay residents.

CONCLUSIONS/IMPLICATIONS:

Lower-quality NHs seem unable to integrate a novel ACP video education program into routine care processes. Ongoing support for and engagement with NH staff to champion the intervention throughout implementation is important for the success of a pragmatic trial within NHs.

KEYWORDS:

Advance care planning; decision aids; nursing home; pragmatic trial; shared decision making

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