Lincoln Medical School, University of Lincoln, Lincoln, UK.
United Lincolnshire Hospitals Trust, Lincoln, UK.
Age Ageing. 2022 Mar 1;51(3). doi: 10.1093/ageing/afac069.
advance care planning (ACP) in care homes has high acceptance, increases the proportion of residents dying in place and reduces hospital admissions in research. We investigated whether ACP had similar outcomes when introduced during real-world service implementation.
a service undertaking ACP in Lincoln, UK care homes was evaluated using routine data. Outcomes were proportion of care homes and residents participating in ACP; characteristics of residents choosing/declining ACP and place of death for those with/without ACP. Hospital admissions were analysed using mixed-effects Poisson regression for number of admissions, and a mixed-effects negative binomial model for number of occupied hospital bed days.
About 15/24 (63%) eligible homes supported the service, in which 404/508 (79.5%) participants chose ACP. Residents choosing ACP were older, frailer, more cognitively impaired and malnourished; 384/404 (95%) residents choosing ACP recorded their care home as their preferred place of death: 380/404 (94%) declined cardiopulmonary resuscitation. Among deceased residents, 219/248 (88%) and 33/49 (67%) with and without advance care plan respectively died in their care home (relative risk 1.35, 95% confidence interval [CI] 1.1-1.6, P < 0.001). Hospital admission rates and bed occupancy did not differ after implementation.
About 79.5% participants chose ACP. Those doing so were more likely to die at home. Many homes were unwilling or unable to support the service. Hospital admissions were not reduced. Further research should consider how to enlist the support of all homes and to explore why hospital admissions were not reduced.
在养老院中进行预先护理计划（ACP）具有较高的接受度，可提高居民在原地死亡的比例并减少住院人数，这在研究中已得到证实。我们调查了在实际服务实施过程中引入 ACP 是否具有类似的效果。
通过常规数据评估了英国林肯市养老院中进行 ACP 的服务。评估的结果包括参与 ACP 的养老院和居民的比例；选择/拒绝 ACP 的居民的特征；以及有/无 ACP 的居民的死亡地点。使用混合效应泊松回归分析住院人数，使用混合效应负二项模型分析占用住院病床天数。
大约有 15/24（63%）家符合条件的养老院支持该服务，其中有 404/508（79.5%）名参与者选择了 ACP。选择 ACP 的居民年龄更大、身体更虚弱、认知能力更差、营养不良；选择 ACP 的 404 名居民中有 384 名（95%）记录了他们希望在养老院去世：380 名（94%）拒绝心肺复苏术。在死亡的居民中，有 219/248（88%）名和 33/49（67%）名有/无预先护理计划的居民分别在养老院去世（相对风险 1.35，95%置信区间[CI] 1.1-1.6，P<0.001）。实施后，住院率和床位占用率没有差异。
大约有 79.5%的参与者选择了 ACP。选择 ACP 的居民更有可能在家中去世。许多养老院不愿意或无法支持这项服务。住院人数并未减少。进一步的研究应考虑如何争取所有养老院的支持，并探讨为什么住院人数没有减少。
