Effect of a Video-Assisted Advance Care Planning Intervention on End-of-Life Health Care Transitions Among Long-Stay Nursing Home Residents.

Abstract

OBJECTIVE\nTo 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.\n\n\nDESIGN\nPragmatic 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.\n\n\nSETTING AND PARTICIPANTS\nPROVEN 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\xa0years who died during the trial who had either advanced dementia or cardiopulmonary disease (advanced illness). We required an observation time ≥90\xa0days before death. The analytic sample included 923 and 1925 advanced illness decedents in intervention and control arms; respectively.\n\n\nMETHODS\nOutcomes 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\xa0days of life, and late transitions (ie, hospital transfer during the last 3\xa0days or hospice admission on the last day of life).\n\n\nRESULTS\nHospital transfers in the last 90\xa0days of life among decedents with advanced illness were significantly lower in the intervention vs control arm (proportion difference\xa0=\xa0-1.7%, 95% CI -3.2%,\xa0-0.1%). The proportion of decedents with multiple hospital transfers and late transitions did not differ between the trial arms.\n\n\nCONCLUSIONS AND IMPLICATIONS\nVideo-assisted ACP was modestly associated with reduced hospital transfers in the last 90\xa0days of life among nursing home residents with advanced illness. The intervention was not significantly associated with late health care transitions and multiple hospital transfers.