Abstract
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.
Keywords
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Article info
Publication history
Published online: October 07, 2021
Footnotes
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.
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© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
