Patience Moyo1, Lacey Loomer2, Joan M Teno3, Roee Gutman4, Ellen M McCreedy5, Emmanuelle Bélanger5, Angelo E Volandes6, Susan L Mitchell7, Vincent Mor8. 1. Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA. Electronic address: patience_moyo@brown.edu. 2. Department of Economics and Health Care Management, University of Minnesota Duluth Labovitz School of Business and Economics, Duluth, MN, USA. 3. Oregon Health Sciences University School of Medicine, Portland, OR, USA. 4. Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA. 5. Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA. 6. General Medicine, Harvard Medical School, Boston, MA, USA; Section of General Medicine, Massachusetts General Hospital, Boston, MA, USA. 7. Hebrew Senior Life, Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. 8. Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Long Term Services and Supports Center of Innovation, Providence VA Medical Center, Providence, RI, USA.
Abstract
OBJECTIVE: To determine the relationship between an advance care planning (ACP) video intervention, Pragmatic Trial of Video Education in Nursing Homes (PROVEN), and end-of-life health care transitions among long-stay nursing home residents with advanced illness. DESIGN: Pragmatic cluster randomized clinical trial. Five ACP videos were available on tablets or online at intervention facilities. PROVEN champions employed by nursing homes (usually social workers) were directed to offer residents (or their proxies) ≥1 video under certain circumstances. Control facilities employed usual ACP practices. SETTING AND PARTICIPANTS: PROVEN occurred from February 2016 to May 2019 in 360 nursing homes (119 intervention, 241 control) owned by 2 health care systems. This post hoc study of PROVEN data analyzed long-stay residents ≥65 years who died during the trial who had either advanced dementia or cardiopulmonary disease (advanced illness). We required an observation time ≥90 days before death. The analytic sample included 923 and 1925 advanced illness decedents in intervention and control arms; respectively. METHODS: Outcomes included the proportion of residents with 1 or more hospital transfer (ie, hospitalization, emergency department use, or observation stay), multiple (≥3) hospital transfers during the last 90 days of life, and late transitions (ie, hospital transfer during the last 3 days or hospice admission on the last day of life). RESULTS: Hospital transfers in the last 90 days of life among decedents with advanced illness were significantly lower in the intervention vs control arm (proportion difference = -1.7%, 95% CI -3.2%, -0.1%). The proportion of decedents with multiple hospital transfers and late transitions did not differ between the trial arms. CONCLUSIONS AND IMPLICATIONS: Video-assisted ACP was modestly associated with reduced hospital transfers in the last 90 days of life among nursing home residents with advanced illness. The intervention was not significantly associated with late health care transitions and multiple hospital transfers.
OBJECTIVE: To determine the relationship between an advance care planning (ACP) video intervention, Pragmatic Trial of Video Education in Nursing Homes (PROVEN), and end-of-life health care transitions among long-stay nursing home residents with advanced illness. DESIGN: Pragmatic cluster randomized clinical trial. Five ACP videos were available on tablets or online at intervention facilities. PROVEN champions employed by nursing homes (usually social workers) were directed to offer residents (or their proxies) ≥1 video under certain circumstances. Control facilities employed usual ACP practices. SETTING AND PARTICIPANTS: PROVEN occurred from February 2016 to May 2019 in 360 nursing homes (119 intervention, 241 control) owned by 2 health care systems. This post hoc study of PROVEN data analyzed long-stay residents ≥65 years who died during the trial who had either advanced dementia or cardiopulmonary disease (advanced illness). We required an observation time ≥90 days before death. The analytic sample included 923 and 1925 advanced illness decedents in intervention and control arms; respectively. METHODS: Outcomes included the proportion of residents with 1 or more hospital transfer (ie, hospitalization, emergency department use, or observation stay), multiple (≥3) hospital transfers during the last 90 days of life, and late transitions (ie, hospital transfer during the last 3 days or hospice admission on the last day of life). RESULTS: Hospital transfers in the last 90 days of life among decedents with advanced illness were significantly lower in the intervention vs control arm (proportion difference = -1.7%, 95% CI -3.2%, -0.1%). The proportion of decedents with multiple hospital transfers and late transitions did not differ between the trial arms. CONCLUSIONS AND IMPLICATIONS: Video-assisted ACP was modestly associated with reduced hospital transfers in the last 90 days of life among nursing home residents with advanced illness. The intervention was not significantly associated with late health care transitions and multiple hospital transfers.
Authors: Lacey Loomer; Ellen McCreedy; Emmanuelle Belanger; Jennifer A Palmer; Susan L Mitchell; Angelo E Volandes; Vincent Mor Journal: J Am Med Dir Assoc Date: 2019-03-07 Impact factor: 4.669
Authors: Angelo E Volandes; Michael K Paasche-Orlow; Susan L Mitchell; Areej El-Jawahri; Aretha Delight Davis; Michael J Barry; Kevan L Hartshorn; Vicki Ann Jackson; Muriel R Gillick; Elizabeth S Walker-Corkery; Yuchiao Chang; Lenny López; Margaret Kemeny; Linda Bulone; Eileen Mann; Sumi Misra; Matt Peachey; Elmer D Abbo; April F Eichler; Andrew S Epstein; Ariela Noy; Tomer T Levin; Jennifer S Temel Journal: J Clin Oncol Date: 2012-12-10 Impact factor: 44.544
Authors: Angelo E Volandes; Laurie Anne Ferguson; Aretha D Davis; Nathan C Hull; Michael J Green; Yuchiao Chang; Kristy Deep; Michael K Paasche-Orlow Journal: J Palliat Med Date: 2011-01-21 Impact factor: 2.947
Authors: Lacey Loomer; Jessica A Ogarek; Susan L Mitchell; Angelo E Volandes; Roee Gutman; Pedro L Gozalo; Ellen M McCreedy; Vincent Mor Journal: J Am Geriatr Soc Date: 2020-11-07 Impact factor: 5.562
Authors: Andrew S Epstein; Angelo E Volandes; Ling Y Chen; Kristen A Gary; Yuelin Li; Patricia Agre; Tomer T Levin; Diane L Reidy; Raymond D Meng; Neil H Segal; Kenneth H Yu; Ghassan K Abou-Alfa; Yelena Y Janjigian; David P Kelsen; Eileen M O'Reilly Journal: J Palliat Med Date: 2013-04-22 Impact factor: 2.947
Authors: Susan L Mitchell; Michele L Shaffer; Simon Cohen; Laura C Hanson; Daniel Habtemariam; Angelo E Volandes Journal: JAMA Intern Med Date: 2018-07-01 Impact factor: 21.873
Authors: Jennifer A Palmer; Victoria A Parker; Lacey R Barre; Vincent Mor; Angelo E Volandes; Emmanuelle Belanger; Lacey Loomer; Ellen McCreedy; Susan L Mitchell Journal: Trials Date: 2019-11-28 Impact factor: 2.279
Authors: Susan L Mitchell; Angelo E Volandes; Roee Gutman; Pedro L Gozalo; Jessica A Ogarek; Lacey Loomer; Ellen M McCreedy; Ruoshui Zhai; Vincent Mor Journal: JAMA Intern Med Date: 2020-08-01 Impact factor: 21.873
Authors: Sheryl Zimmerman; Barbara Resnick; Joseph Ouslander; Cari Levy; Joseph E Gaugler; Philip D Sloane; Vincent Mor Journal: J Am Geriatr Soc Date: 2022-02-23 Impact factor: 5.562
Authors: Sheryl Zimmerman; Barbara Resnick; Joseph Ouslander; Cari Levy; Joseph E Gaugler; Philip D Sloane; Vincent Mor Journal: Geriatr Nurs Date: 2022-02-24 Impact factor: 2.361
Authors: Sheryl Zimmerman; Barbara Resnick; Joseph Ouslander; Cari Levy; Joseph E Gaugler; Philip D Sloane; Vincent Mor Journal: J Am Med Dir Assoc Date: 2022-03 Impact factor: 4.669
Authors: Andre Carlos Kajdacsy-Balla Amaral; Andrea D Hill; Ruxandra Pinto; Longdi Fu; Anne Morinville; George Heckman; Paul Hébert; John Hirdes Journal: Medicine (Baltimore) Date: 2022-10-14 Impact factor: 1.817
Authors: Ellen M McCreedy; Xiaofei Yang; Susan L Mitchell; Roee Gutman; Joan Teno; Lacey Loomer; Patience Moyo; Angelo Volandes; Pedro L Gozalo; Emmanuelle Belanger; Jessica Ogarek; Vincent Mor Journal: BMC Geriatr Date: 2022-04-08 Impact factor: 3.921