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.
J Am Med Dir Assoc. 2019 Jul;20(7):804-809.e1. doi: 10.1016/j.jamda.2019.01.133. Epub 2019 Mar 7.
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.
Cross-sectional study of NHs in PROVEN.
119 NHs randomized to receive the ACP video intervention.
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.
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.
预先医疗照护计划（ACP）对于确保疗养院（NH）居民获得与其目标相符的护理至关重要。已经开发了视频干预措施来改善 ACP 流程。然而，对于哪些 NH 特征与临床实践中 ACP 视频干预的实施相关，我们知之甚少。我们的目标是检查与实施 ACP 视频干预相关的 NH 特征，这是在养老院中的视频教育实用试验（PROVEN）中。
PROVEN 中的 NH 横断面研究。
119 家随机分配接受 ACP 视频干预的 NH。
结果是接受观看视频的短期（<100 天）和长期（≥100 天）NH 居民的比例（1），并将其汇总到 NH 水平，使用视频提供的电子表格进行测量。使用多元线性回归模型，根据 NH 设施特征（例如人员配备、居民病情严重程度）和参与 PROVEN 试验的其他方面（例如每月入住电话）与结果之间的关联来估计结果。NH 特征使用来自在线调查认证和报告数据、长期护理：美国护理事实和 NH 比较的数据进行测量。
短期居住者的提供率为 69%（标准差[SD]：28），长期居住者为 56%（SD：20）。短期居住者的展示率为 19%（SD：21），长期居住者为 17%（SD：17）。在调整 NH 特征后，与 1 星级 NH 相比，星级较高的 NH 提供率更高。冠军参与入住电话与长期居住者的这两个结果均呈正相关。
结论/含义： 质量较低的 NH 似乎无法将新的 ACP 视频教育计划纳入常规护理流程。在 NH 内实施实用试验时，需要持续支持和与 NH 工作人员的互动，以倡导干预措施。
