Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; Faculty of Nursing, Mahidol University, Bangkok, Thailand.
Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.
J Am Med Dir Assoc. 2022 Sep;23(9):1448-1460.e1. doi: 10.1016/j.jamda.2022.07.017. Epub 2022 Aug 11.
To evaluate the effect of advance care planning (ACP) interventions on the hospitalization of nursing home residents.
Systematic review and meta-analysis.
Nursing homes and nursing home residents.
A literature search was systematically conducted in 6 electronic databases (Embase, Ovid MEDLINE, Cochrane Library, CINAHL, AgeLine, and the Psychology & Behavioral Sciences Collection), in addition to hand searches and reference list checking; the articles retrieved were those published from 1990 to November 2021. The eligible studies were randomized controlled trials, controlled trials, and pre-post intervention studies describing original data on the effect of ACP on hospitalization of nursing home residents; these studies had to be written in English. Two independent reviewers appraised the quality of the studies and extracted the relevant data using the Joanna Briggs Institute abstraction form and critical appraisal tools. A study protocol was registered in PROSPERO (CRD42022301648).
The initial search yielded 744 studies. Nine studies involving a total of 57,180 residents were included in the review. The findings showed that the ACP reduced the likelihood of hospitalization [relative risk (RR) 0.54, 95% CI 0.47-0.63; I = 0%)], it had no effect on emergency department (ED) visits (RR 0.60, 95% CI 0.31-1.42; I = 99), hospice enrollment (RR 0.98, 95% CI 0.88-1.10; I = 0%), mortality (RR 0.83, 95% CI 0.68-1.00; I = 4%), and satisfaction with care (standardized mean difference: -0.04, 95% CI -0.14 to -0.06; I = 0%).
ACP reduced hospitalizations but did not affect the secondary outcomes, namely, ED visits, hospice enrollment, mortality, and satisfaction with care. These findings suggest that policy makers should support the implementation of ACP programs in nursing homes. More robust studies are needed to determine the effects of ACP on ED visits, hospice enrollment, mortality, and satisfaction with care.
评估预先护理计划（ACP）干预对养老院居民住院的影响。
系统评价和荟萃分析。
养老院和养老院居民。
系统地在 6 个电子数据库（Embase、Ovid MEDLINE、Cochrane 图书馆、CINAHL、AgeLine 和心理学与行为科学收藏）中进行文献检索，此外还进行了手工检索和参考文献检查；检索到的文章是 1990 年至 2021 年 11 月发表的描述 ACP 对养老院居民住院影响的原始数据的随机对照试验、对照试验和干预前后研究；这些研究必须用英文书写。两名独立评审员使用 Joanna Briggs 研究所提取表和批判性评价工具评估研究质量并提取相关数据。研究方案已在 PROSPERO（CRD42022301648）中注册。
最初的搜索产生了 744 项研究。共有 9 项研究，共涉及 57180 名居民，被纳入综述。研究结果表明，ACP 降低了住院的可能性[相对风险（RR）0.54，95%置信区间 0.47-0.63；I = 0%]，对急诊部（ED）就诊没有影响（RR 0.60，95%置信区间 0.31-1.42；I = 99%），也没有影响临终关怀登记（RR 0.98，95%置信区间 0.88-1.10；I = 0%）、死亡率（RR 0.83，95%置信区间 0.68-1.00；I = 4%）和护理满意度（标准化均数差：-0.04，95%置信区间-0.14 至-0.06；I = 0%）。
ACP 降低了住院率，但没有影响次要结局，即 ED 就诊、临终关怀登记、死亡率和护理满意度。这些发现表明，政策制定者应支持在养老院实施 ACP 计划。需要更有力的研究来确定 ACP 对 ED 就诊、临终关怀登记、死亡率和护理满意度的影响。
