Background: The purpose of the study is to evaluate the effect of an Advance Care Planning (ACP) Video Program on documented Do-Not-Hospitalize (DNH) orders among nursing home (NH) residents with advanced illness.
Methods: Secondary analysis on a subset of NHs enrolled in a cluster-randomized controlled trial (41 NHs in treatment arm implemented the ACP Video Program: 69 NHs in control arm employed usual ACP practices). Participants included long (> 100 days) and short (≤ 100 days) stay residents with advanced illness (advanced dementia or cardiopulmonary disease (chronic obstructive pulmonary disease or congestive heart failure)) in NHs from March 1, 2016 to May 31, 2018 without a documented Do-Not-Hospitalize (DNH) order at baseline. Logistic regression with covariate adjustments was used to estimate the impact of the resident being in a treatment versus control NH on: the proportion of residents with new DNH orders during follow-up; and the proportion of residents with any hospitalization during follow-up. Clustering at the facility-level was addressed using hierarchical models.
Results: The cohort included 6,117 residents with advanced illness (mean age (SD) = 82.8 (8.4) years, 65% female). Among long-stay residents (n = 3,902), 9.3% (SE, 2.2; 95% CI 5.0-13.6) and 4.2% (SE, 1.1; 95% CI 2.1-6.3) acquired a new DNH order in the treatment and control arms, respectively (average marginal effect, (AME) 5.0; SE, 2.4; 95% CI, 0.3-9.8). Among short-stay residents with advanced illness (n = 2,215), 8.0% (SE, 1.6; 95% CI 4.6-11.3) and 3.5% (SE 1.0; 95% CI 1.5-5.5) acquired a new DNH order in the treatment and control arms, respectively (AME 4.4; SE, 2.0; 95% CI, 0.5-8.3). Proportion of residents with any hospitalizations did not differ between arms in either cohort.
Conclusions: Compared to usual care, an ACP Video Program intervention increased documented DNH orders among NH residents with advanced disease but did not significantly reduce hospitalizations.
Trial Registration: ClinicalTrials.gov Identifier: NCT02612688 .
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8991654 | PMC |
| http://dx.doi.org/10.1186/s12877-022-02970-3 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Surgical consideration and practical difficulty in malignant otitis externa: a systematic review.
Eur Arch Otorhinolaryngol
January 2025
Department of Otology, King Saud University, Riyadh, 11421, Saudi Arabia.
Purpose: This systematic review aims to explore the role of surgery in managing Malignant Otitis Externa (MOE) by analyzing surgical considerations, treatment duration, responses, and patient outcomes.
Methods: A comprehensive search was conducted across PubMed, Science Direct, Google Scholar, and Cochrane Library databases between 2003 and February 2023. Studies meeting inclusion criteria detailed MOE cases, patient medical profiles, surgical procedures undertaken, and treatment outcomes.
Consequences of Historical Exam Access versus Timely Exam feedback on knowledge Retention (CHEATER).
Am J Pharm Educ
January 2025
UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599. Electronic address:
Objective: To compare the impact of examination feedback versus access to historical examination questions on information retention.
Methods: First-year student-pharmacists completed a baseline knowledge assessment composed of 30 examination questions divided into three conditions of 10 questions each. In the CHEAT condition, students were provided with 10 questions and their correct answers ahead of time.
"And Still We Rise: Advances in Diversity, Equity, Inclusion, and Antiracism in Academic Pediatrics".
Acad Pediatr
January 2025
Department of Pediatrics, University of California San Francisco, San Francisco, CA.
Consistent direction despite wavering policy: reductions in resident physician extended duration shifts over 20 years.
Am J Med
January 2025
Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA; Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
We examined data from 17,498 physicians-in-training who reported on 92,662 months of work over a 20 year study interval that included three major revisions to work hour limits. Extended duration shifts (≥24 hours; EDS) are much less common than they used to be. On average, first-year resident physicians (PGY1s) currently work a total of 4 EDS per year and 3 EDS per month during months in which any EDS are worked.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!