End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
J Am Med Dir Assoc. 2020 Dec;21(12):1973-1978.e2. doi: 10.1016/j.jamda.2020.05.003. Epub 2020 Jul 6.
PACE Steps to Success is a 1-year train-the-trainer program aiming to integrate nonspecialist palliative care into nursing homes via staff education and organizational support. In this study, we aimed to explore whether this program resulted in changes in residents' hospital use and place of death.
Secondary analysis of the PACE cluster randomized controlled trial (ISRCTN14741671). Data were collected on deaths over the previous 4 months via questionnaires at baseline and postintervention.
Questionnaires were completed by the nurse/care-assistant most involved from 78 nursing homes in 7 European Union countries.
We measured number of emergency department visits, hospital admissions, length of hospital stay, and place of death. Baseline and postintervention scores between intervention and control groups were compared, and we conducted exploratory mixed-model analyses. We collected 551 out of 610 questionnaires at baseline and 984 out of 1178 at postintervention in 37 intervention and 36 control homes.
We found no statistical significant effects of the program on emergency department visits [odds ratio (OR) = 1.38, P = .32], hospital admissions (OR = 0.98, P = .93), length of hospital stay (geometric mean difference = 0.85, P = .44), or place of death (OR = 1.08, P = .80).
We found no effect of the PACE program on either hospital use in the last month of life or place of death. Although this may be related to implementation problems in some homes, the program might also require a more specific focus on managing acute end-of-life situations and a closer involvement of general practitioners or specialist palliative care services to influence hospital use or place of death.
PACE 成功步骤是一项为期 1 年的培训师培训计划，旨在通过员工教育和组织支持将非专业姑息治疗融入养老院。在本研究中，我们旨在探讨该计划是否会导致居民住院使用和死亡地点的变化。
PACE 集群随机对照试验（ISRCTN67753341）的二次分析。通过基线和干预后的问卷收集过去 4 个月内的死亡数据。
来自 7 个欧盟国家的 78 家养老院的护士/护理助理最了解情况的人填写了问卷。
我们测量了急诊就诊次数、住院入院次数、住院时间和死亡地点。比较了干预组和对照组的基线和干预后得分，并进行了探索性混合模型分析。我们在 37 个干预组和 36 个对照组中收集了基线时的 551 份问卷和干预后 984 份问卷。
我们没有发现该计划对急诊就诊（优势比 [OR] = 1.38，P =.32）、住院入院（OR = 0.98，P =.93）、住院时间（几何均数差异 = 0.85，P =.44）或死亡地点（OR = 1.08，P =.80）有统计学显著影响。
我们没有发现 PACE 计划对生命最后一个月的住院使用或死亡地点有任何影响。尽管这可能与一些家庭的实施问题有关，但该计划可能还需要更具体地关注管理急性临终情况，并更密切地参与全科医生或专科姑息治疗服务，以影响住院使用或死亡地点。
