预立医疗照护计划视频干预对短期住院疗养院患者护理的影响。
Impact of an Advance Care Planning Video Intervention on Care of Short-Stay Nursing Home Patients.
机构信息
Department of Economics, Labovitz School of Business and Economics, Duluth, Minnesota, USA.
Centers for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA.
出版信息
J Am Geriatr Soc. 2021 Mar;69(3):735-743. doi: 10.1111/jgs.16918. Epub 2020 Nov 7.
BACKGROUND/OBJECTIVES: To assess whether an advance care planning (ACP) video intervention impacts care among short-stay nursing home (NH) patients.
DESIGN
PRagmatic trial of Video Education in Nursing Homes (PROVEN) was a pragmatic cluster randomized clinical trial.
SETTING
A total of 360 NHs (N = 119 intervention, N = 241 control) owned by two healthcare systems.
PARTICIPANTS
A total of 2,538 and 5,290 short-stay patients with advanced dementia or cardiopulmonary disease (advanced illness) in the intervention and control arms, respectively; 23,302 and 50,815 short-stay patients without advanced illness in the intervention and control arms, respectively.
INTERVENTION
Five ACP videos were available on tablets or online. Designated champions at each intervention facility were instructed to offer a video to patients (or proxies) on admission. Control facilities used usual ACP practices.
MEASUREMENTS
Follow-up time was at most 100 days for each patient. Outcomes included hospital transfers per 1000 person-days alive and the proportion of patients experiencing more than one hospital transfer, more than one burdensome treatment (tube-feeding, parenteral therapy, invasive mechanical intervention, and intensive care unit admission), and hospice enrollment. Champions recorded whether a video was offered in the patients' electronic medical record.
RESULTS
There was no significant reduction in hospital transfers per 1000 person-days alive in the intervention versus control groups with advanced illness (rate (95% confidence interval (CI)), 12.3 (11.6-13.1) vs 13.2 (12.5-13.7); rate difference: -0.8; 95% CI = -1.8-0.2)). There was a nonsignificant reduction in hospital transfers per 1000 person-days alive in the intervention versus control among short-stay patients without advanced illness. Secondary outcomes did not differ between groups among patients with and without advanced illness. Based on champion only reports 14.2% and 15.3% of eligible short-stay patients with and without advanced illness were shown videos, respectively.
CONCLUSION
An ACP video program did not significantly reduce hospital transfers, burdensome treatment, or hospice enrollment among short-stay NH patients; however, fidelity to the intervention was low.
背景/目的：评估预先护理计划（ACP）视频干预是否会影响短期疗养院（NH）患者的护理。
设计
在疗养院进行视频教育的实用试验（PROVEN）是一项实用的集群随机临床试验。
地点
总共 360 家由两个医疗保健系统拥有的 NH（N = 119 个干预组，N = 241 个对照组）。
参与者
干预组和对照组分别有 2538 名和 5290 名患有晚期痴呆或心肺疾病（晚期疾病）的短期住院患者；干预组和对照组分别有 23302 名和 50815 名没有晚期疾病的短期住院患者。
干预措施
五部 ACP 视频可在平板电脑或在线观看。每个干预设施的指定负责人被指示在入院时向患者（或其代理人）提供视频。对照组使用常规的 ACP 实践。
测量
每个患者的随访时间最多为 100 天。结果包括每 1000 人存活日的住院转移次数，以及经历一次以上住院转移、一次以上负担过重的治疗（管饲、肠外治疗、有创机械干预和重症监护病房入院）和临终关怀登记的患者比例。负责人记录了患者电子病历中是否提供了视频。
结果
在患有晚期疾病的患者中，与对照组相比，干预组每 1000 人存活日的住院转移次数没有显著减少（发生率（95%置信区间（CI）），12.3（11.6-13.1）与 13.2（12.5-13.7）；发生率差异：-0.8；95%CI=-1.8-0.2））。在没有晚期疾病的短期住院患者中，与对照组相比，每 1000 人存活日的住院转移次数也没有显著减少。在患有和不患有晚期疾病的患者中，次要结局在组间没有差异。根据负责人的报告，分别有 14.2%和 15.3%的符合条件的短期住院患者有和没有晚期疾病的患者观看了视频。
结论
ACP 视频计划并没有显著减少短期 NH 患者的住院转移、负担过重的治疗或临终关怀登记；然而，对干预措施的遵从性很低。
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