Alzheimer Disease, Dementia, Heart Failure, Pulmonary Disease, Chronic Obstructive
Conditions
Keywords
Advance Care Planning, Advance Directives, Alzheimer Disease, Dementia, Do-Not-Resuscitate Orders, Enteral Nutrition, Heart Failure, Hospices, Hospitalization, Instructional Films and Videos, Intubation, Nursing Homes, Parenteral Nutrition, Pragmatic Clinical Trials, Pulmonary Disease, Chronic Obstructive, Randomized Controlled Trials, Resuscitation Orders, Skilled Nursing Facilities
Brief summary
This is a pragmatic cluster-randomized control trial (RCT) of an Advance Care Planning (ACP) Video Program for nursing home (NH) patients ≥ 65 years old who are cared for in 360 NH facilities (intervention arm n=119; control arm n=241) within two NH health care systems: Genesis HealthCare and PruittHealth. The intervention NH facilities will implement the ACP Video Program, while the control NH facilities will follow their usual ACP procedures. The trial will evaluate the effectiveness of the ACP Video Program by comparing hospitalizations, advance directives, and hospice use in the intervention vs. control NHs.
Detailed description
Nursing homes are complex health care systems that serve increasingly sick patients who have advanced comorbid conditions. NHs are often charged with guiding patients through decisions about the direction of their treatment. Patients at NHs commonly get aggressive care that may be inconsistent with their preferences and of little clinical benefit. Identifying effective approaches that NHs can use to better promote goal-directed care and optimize resources is a research, public health, and clinical priority. Advance care planning is the most consistent modifiable factor associated with better palliative care outcomes. Traditional ACP relies on verbal descriptions of hypothetical health states and treatments. This approach is limited because complex scenarios are difficult to envision, counseling is inconsistent, and verbal explanations are hindered by literacy and language barriers. To address these shortcomings, the PROVEN project has developed video-assisted ACP decision-support tools that have shown efficacy in small randomized controlled trials. While several large health care systems have begun to adopt the videos, efforts have not rigorously evaluated outcomes-a critical step prior to widespread implementation. The goal of PROVEN is to conduct a pragmatic cluster-randomized trial to evaluate the effectiveness of the ACP Video Program in the NH setting by partnering with 2 large health care systems that operate 456 nursing homes nationwide. This work has the potential to improve the care provided to millions of older Americans in nursing homes and enable future pragmatic trials in this setting.
Interventions
BEHAVIORALACP Video Program
The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).
Sponsors
National Institute on Aging (NIA)
Hebrew SeniorLife
Massachusetts General Hospital
Genesis HealthCare
PruittHealth
Brown University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Facilities are within Genesis HealthCare or PruittHealth health care systems * Facilities have facility identifiers that indicate that they are Medicare/Medicaid-certified nursing facilities in the U.S. * Facilities serve both short and long-stay patients * Facilities have \>50 beds * Facilities have an electronic medical records system * Facilities had at least 20 admissions and 20 annual Minimum Data Set (MDS) assessments (regardless of whether they were discharged alive) in 2013
Exclusion criteria
* Facilities excluded per corporate leaders in health care system because of recent turnover in NH administrator or Director of Nursing * Facilities excluded per corporate leaders in health care system because of recent bad state or federal quality assurance survey (e.g. restriction on admissions, levied large civil monetary penalty, etc.) * Facilities excluded per corporate leaders in health care system because of current new initiatives/competing demands
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hospital Transfer Rate in Target Cohort | 12-month observation period | Number of hospital transfers (number of transfers/person-days alive) over a 12-month observation period among Medicare fee-for-service long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have EITHER advanced dementia or advanced congestive heart failure/chronic obstructive lung disease |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospital Transfer Rate Among Short-stay Residents With Advanced Illness | 100-day observation period | Number of hospital transfers (number of transfers/person-days alive) over a 100-day observation period among Medicare fee-for-service short-stay residents (in a NH \<90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease |
| Hospital Transfer Rate Among Short-stay Residents Without Advanced Illness | 100-day observation period | Number of hospital transfers (number of transfers/person-days alive) over a 100-day observation period among Medicare fee-for-service short-stay residents (in a NH \<90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease |
| Proportion of Target Cohort With Last Observed Advance Directive Status | 12-month observation period | Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease whose last observed advance directive status during their 12-month observation period was: Full Code, Do Not Resuscitate (NOT Do Not Hospitalize), or Do Not Hospitalize. A resident whose last observed status was both Do Not Resuscitate and Do Not Hospitalize is categorized as Do Not Hospitalize only. Analyses will be limited to Genesis HealthCare facilities in which \>75% of residents have any advance directive because the remaining Genesis HealthCare and PruittHealth facilities do not have reliable sources for these data. |
| Proportion of Long-stay Residents Without Advanced Illness With Last Observed Advance Directive Status | 12-month observation period | Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who do have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease whose last observed advance directive status during their 12-month observation period was: Full Code, Do Not Resuscitate (NOT Do Not Hospitalize), or Do Not Hospitalize. A resident whose last observed status was both Do Not Resuscitate and Do Not Hospitalize is categorized as Do Not Hospitalize only. Analyses will be limited to Genesis HealthCare facilities in which \>75% of residents have any advance directive because the remaining Genesis HealthCare and PruittHealth facilities do not have reliable sources for these data. |
| Proportion of Short-stay Residents With Advanced Illness With Last Observed Advance Directive Status | 100-day observation period | Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease whose last observed advance directive status during their 100-day observation period was: Full Code, Do Not Resuscitate (NOT Do Not Hospitalize), or Do Not Hospitalize. A resident whose last observed status was both Do Not Resuscitate and Do Not Hospitalize is categorized as Do Not Hospitalize only. Analyses will be limited to Genesis HealthCare facilities in which \>75% of residents have any advance directive because the remaining Genesis HealthCare and PruittHealth facilities do not have reliable sources for these data. |
| Proportion of Short-stay Residents Without Advanced Illness With Last Observed Advance Directive Status | 100-day observation period | Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease whose last observed advance directive status during their 100-day observation period was: Full Code, Do Not Resuscitate (NOT Do Not Hospitalize), or Do Not Hospitalize. A resident whose last observed status was both Do Not Resuscitate and Do Not Hospitalize is categorized as Do Not Hospitalize only. Analyses will be limited to Genesis HealthCare facilities in which \>75% of residents have any advance directive because the remaining Genesis HealthCare and PruittHealth facilities do not have reliable sources for these data. |
| Proportion of Target Cohort Receiving Any Burdensome Treatment | 12-month observation period | Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease who receive any burdensome treatment (new feeding tube insertions, parenteral therapy, intubation, ICU care) during a 12-month observation period |
| Proportion of Long-stay Residents Without Advanced Illness Receiving Any Burdensome Treatment | 12-month observation period | Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease who receive any burdensome treatment (new feeding tube insertions, parenteral therapy, intubation, ICU care) during a 12-month observation period |
| Proportion of Short-stay Residents With Advanced Illness Receiving Any Burdensome Treatment | 100-day observation period | Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease who receive any burdensome treatment (new feeding tube insertions, parenteral therapy, intubation, ICU care) during a 100-day observation period among |
| Hospital Transfer Rate Among Long-stay Residents Without Advanced Illness | 12-month observation period | Number of hospital transfers (number of transfers/person-days alive) over a 12-month observation period among Medicare fee-for-service long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease |
| Proportion of Target Cohort With Any Hospice Enrollment | 12-month observation period | Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease with any hospice enrollment during a 12-month observation period |
| Proportion of Long-stay Residents Without Advanced Illness With Any Hospice Enrollment | 12-month observation period | Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease with any hospice enrollment during a 12-month observation period |
| Proportion of Short-stay Residents With Advanced Illness With Any Hospice Enrollment | 100-day observation period | Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease with any hospice enrollment during a 100-day observation period |
| Proportion of Short-stay Residents Without Advanced Illness With Any Hospice Enrollment | 100-day observation period | Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease with any hospice enrollment during a 100-day observation period |
| Proportion of Target Cohort That Has Medicare ACP Billing Codes | 12-month observation period | Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease who have any Medicare ACP billing code during their 12-month observation period |
| Proportion of Long-stay Residents Without Advanced Illness That Has Medicare ACP Billing Codes | 12-month observation period | Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease who have any Medicare ACP billing code during their 12-month observation period |
| Proportion of Short-stay Residents With Advanced Illness That Has Medicare ACP Billing Codes | 100-day observation period | Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease who have any Medicare ACP billing code during their 100-day observation period |
| Proportion of Short-stay Residents Without Advanced Illness That Has Medicare ACP Billing Codes | 100-day observation period | Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease who have any Medicare ACP billing code during their 100-day observation period |
| Proportion of Short-stay Residents Without Advanced Illness Receiving Any Burdensome Treatment | 100-day observation period | Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease who receive any burdensome treatment (new feeding tube insertions, parenteral therapy, intubation, ICU care) during a 100-day observation period |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Advance Care Planning (ACP) Video Program Facility asked to implement Advance Care Planning (ACP) Video Program
ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting). | 33,035 |
| Usual Advance Care Planning (ACP) Procedures Facility follows usual Advance Care Planning (ACP) procedures | 70,013 |
| Total | 103,048 |
Baseline characteristics
| Characteristic | Advance Care Planning (ACP) Video Program | Usual Advance Care Planning (ACP) Procedures | Total |
|---|---|---|---|
| Age, Continuous | 80.8 years STANDARD_DEVIATION 8.9 | 80.9 years STANDARD_DEVIATION 8.8 | 80.9 years STANDARD_DEVIATION 8.9 |
| Race/Ethnicity, Customized Race/Ethnicity Asian | 240 Participants | 617 Participants | 857 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Black | 4904 Participants | 8575 Participants | 13479 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Hispanic | 287 Participants | 626 Participants | 913 Participants |
| Race/Ethnicity, Customized Race/Ethnicity North American Native | 331 Participants | 407 Participants | 738 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Other | 215 Participants | 491 Participants | 706 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Unknown | 170 Participants | 425 Participants | 595 Participants |
| Race/Ethnicity, Customized Race/Ethnicity White | 26888 Participants | 58872 Participants | 85760 Participants |
| Sex: Female, Male Female | 19818 Participants | 42170 Participants | 61988 Participants |
| Sex: Female, Male Male | 13217 Participants | 27843 Participants | 41060 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 8,403 / 33,035 | 17,251 / 70,013 |
| other Total, other adverse events | 0 / 33,035 | 0 / 70,013 |
| serious Total, serious adverse events | 0 / 33,035 | 0 / 70,013 |
Outcome results
Primary
Hospital Transfer Rate in Target Cohort
Number of hospital transfers (number of transfers/person-days alive) over a 12-month observation period among Medicare fee-for-service long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have EITHER advanced dementia or advanced congestive heart failure/chronic obstructive lung disease
Time frame: 12-month observation period
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| ACP Video Program | Hospital Transfer Rate in Target Cohort | 2.4 person-years | Standard Deviation 11.8 |
| Usual ACP Procedures | Hospital Transfer Rate in Target Cohort | 2.8 person-years | Standard Deviation 13.7 |
Secondary
Hospital Transfer Rate Among Long-stay Residents Without Advanced Illness
Number of hospital transfers (number of transfers/person-days alive) over a 12-month observation period among Medicare fee-for-service long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease
Time frame: 12-month observation period
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| ACP Video Program | Hospital Transfer Rate Among Long-stay Residents Without Advanced Illness | 1.65 person-years | Standard Deviation 3.9 |
| Usual ACP Procedures | Hospital Transfer Rate Among Long-stay Residents Without Advanced Illness | 1.68 person-years | Standard Deviation 4.8 |
Secondary
Hospital Transfer Rate Among Short-stay Residents With Advanced Illness
Number of hospital transfers (number of transfers/person-days alive) over a 100-day observation period among Medicare fee-for-service short-stay residents (in a NH \<90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease
Time frame: 100-day observation period
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| ACP Video Program | Hospital Transfer Rate Among Short-stay Residents With Advanced Illness | 6.9 person-years | Standard Deviation 17.8 |
| Usual ACP Procedures | Hospital Transfer Rate Among Short-stay Residents With Advanced Illness | 6.8 person-years | Standard Deviation 16.8 |
Secondary
Hospital Transfer Rate Among Short-stay Residents Without Advanced Illness
Number of hospital transfers (number of transfers/person-days alive) over a 100-day observation period among Medicare fee-for-service short-stay residents (in a NH \<90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease
Time frame: 100-day observation period
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| ACP Video Program | Hospital Transfer Rate Among Short-stay Residents Without Advanced Illness | 4.5 person-years | Standard Deviation 10.3 |
| Usual ACP Procedures | Hospital Transfer Rate Among Short-stay Residents Without Advanced Illness | 4.4 person-years | Standard Deviation 10.4 |
Secondary
Proportion of Long-stay Residents Without Advanced Illness Receiving Any Burdensome Treatment
Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease who receive any burdensome treatment (new feeding tube insertions, parenteral therapy, intubation, ICU care) during a 12-month observation period
Time frame: 12-month observation period
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ACP Video Program | Proportion of Long-stay Residents Without Advanced Illness Receiving Any Burdensome Treatment | 465 Participants |
| Usual ACP Procedures | Proportion of Long-stay Residents Without Advanced Illness Receiving Any Burdensome Treatment | 1028 Participants |
Secondary
Proportion of Long-stay Residents Without Advanced Illness That Has Medicare ACP Billing Codes
Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease who have any Medicare ACP billing code during their 12-month observation period
Time frame: 12-month observation period
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ACP Video Program | Proportion of Long-stay Residents Without Advanced Illness That Has Medicare ACP Billing Codes | 571 Participants |
| Usual ACP Procedures | Proportion of Long-stay Residents Without Advanced Illness That Has Medicare ACP Billing Codes | 1157 Participants |
Secondary
Proportion of Long-stay Residents Without Advanced Illness With Any Hospice Enrollment
Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease with any hospice enrollment during a 12-month observation period
Time frame: 12-month observation period
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ACP Video Program | Proportion of Long-stay Residents Without Advanced Illness With Any Hospice Enrollment | 373 Participants |
| Usual ACP Procedures | Proportion of Long-stay Residents Without Advanced Illness With Any Hospice Enrollment | 832 Participants |
Secondary
Proportion of Long-stay Residents Without Advanced Illness With Last Observed Advance Directive Status
Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who do have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease whose last observed advance directive status during their 12-month observation period was: Full Code, Do Not Resuscitate (NOT Do Not Hospitalize), or Do Not Hospitalize. A resident whose last observed status was both Do Not Resuscitate and Do Not Hospitalize is categorized as Do Not Hospitalize only. Analyses will be limited to Genesis HealthCare facilities in which \>75% of residents have any advance directive because the remaining Genesis HealthCare and PruittHealth facilities do not have reliable sources for these data.
Time frame: 12-month observation period
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| ACP Video Program | Proportion of Long-stay Residents Without Advanced Illness With Last Observed Advance Directive Status | Full Code | 1150 Participants |
| ACP Video Program | Proportion of Long-stay Residents Without Advanced Illness With Last Observed Advance Directive Status | Do Not Resuscitate | 1714 Participants |
| ACP Video Program | Proportion of Long-stay Residents Without Advanced Illness With Last Observed Advance Directive Status | Do Not Hospitalize | 369 Participants |
| Usual ACP Procedures | Proportion of Long-stay Residents Without Advanced Illness With Last Observed Advance Directive Status | Full Code | 2210 Participants |
| Usual ACP Procedures | Proportion of Long-stay Residents Without Advanced Illness With Last Observed Advance Directive Status | Do Not Resuscitate | 3018 Participants |
| Usual ACP Procedures | Proportion of Long-stay Residents Without Advanced Illness With Last Observed Advance Directive Status | Do Not Hospitalize | 431 Participants |
Secondary
Proportion of Short-stay Residents With Advanced Illness Receiving Any Burdensome Treatment
Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease who receive any burdensome treatment (new feeding tube insertions, parenteral therapy, intubation, ICU care) during a 100-day observation period among
Time frame: 100-day observation period
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ACP Video Program | Proportion of Short-stay Residents With Advanced Illness Receiving Any Burdensome Treatment | 294 Participants |
| Usual ACP Procedures | Proportion of Short-stay Residents With Advanced Illness Receiving Any Burdensome Treatment | 621 Participants |
Secondary
Proportion of Short-stay Residents With Advanced Illness That Has Medicare ACP Billing Codes
Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease who have any Medicare ACP billing code during their 100-day observation period
Time frame: 100-day observation period
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ACP Video Program | Proportion of Short-stay Residents With Advanced Illness That Has Medicare ACP Billing Codes | 224 Participants |
| Usual ACP Procedures | Proportion of Short-stay Residents With Advanced Illness That Has Medicare ACP Billing Codes | 479 Participants |
Secondary
Proportion of Short-stay Residents With Advanced Illness With Any Hospice Enrollment
Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease with any hospice enrollment during a 100-day observation period
Time frame: 100-day observation period
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ACP Video Program | Proportion of Short-stay Residents With Advanced Illness With Any Hospice Enrollment | 588 Participants |
| Usual ACP Procedures | Proportion of Short-stay Residents With Advanced Illness With Any Hospice Enrollment | 1220 Participants |
Secondary
Proportion of Short-stay Residents With Advanced Illness With Last Observed Advance Directive Status
Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease whose last observed advance directive status during their 100-day observation period was: Full Code, Do Not Resuscitate (NOT Do Not Hospitalize), or Do Not Hospitalize. A resident whose last observed status was both Do Not Resuscitate and Do Not Hospitalize is categorized as Do Not Hospitalize only. Analyses will be limited to Genesis HealthCare facilities in which \>75% of residents have any advance directive because the remaining Genesis HealthCare and PruittHealth facilities do not have reliable sources for these data.
Time frame: 100-day observation period
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| ACP Video Program | Proportion of Short-stay Residents With Advanced Illness With Last Observed Advance Directive Status | Full Code | 482 Participants |
| ACP Video Program | Proportion of Short-stay Residents With Advanced Illness With Last Observed Advance Directive Status | Do Not Resuscitate | 581 Participants |
| ACP Video Program | Proportion of Short-stay Residents With Advanced Illness With Last Observed Advance Directive Status | Do Not Hospitalize | 103 Participants |
| Usual ACP Procedures | Proportion of Short-stay Residents With Advanced Illness With Last Observed Advance Directive Status | Full Code | 761 Participants |
| Usual ACP Procedures | Proportion of Short-stay Residents With Advanced Illness With Last Observed Advance Directive Status | Do Not Resuscitate | 858 Participants |
| Usual ACP Procedures | Proportion of Short-stay Residents With Advanced Illness With Last Observed Advance Directive Status | Do Not Hospitalize | 82 Participants |
Secondary
Proportion of Short-stay Residents Without Advanced Illness Receiving Any Burdensome Treatment
Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease who receive any burdensome treatment (new feeding tube insertions, parenteral therapy, intubation, ICU care) during a 100-day observation period
Time frame: 100-day observation period
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ACP Video Program | Proportion of Short-stay Residents Without Advanced Illness Receiving Any Burdensome Treatment | 1726 Participants |
| Usual ACP Procedures | Proportion of Short-stay Residents Without Advanced Illness Receiving Any Burdensome Treatment | 3405 Participants |
Secondary
Proportion of Short-stay Residents Without Advanced Illness That Has Medicare ACP Billing Codes
Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease who have any Medicare ACP billing code during their 100-day observation period
Time frame: 100-day observation period
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ACP Video Program | Proportion of Short-stay Residents Without Advanced Illness That Has Medicare ACP Billing Codes | 1669 Participants |
| Usual ACP Procedures | Proportion of Short-stay Residents Without Advanced Illness That Has Medicare ACP Billing Codes | 4068 Participants |
Secondary
Proportion of Short-stay Residents Without Advanced Illness With Any Hospice Enrollment
Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease with any hospice enrollment during a 100-day observation period
Time frame: 100-day observation period
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ACP Video Program | Proportion of Short-stay Residents Without Advanced Illness With Any Hospice Enrollment | 2273 Participants |
| Usual ACP Procedures | Proportion of Short-stay Residents Without Advanced Illness With Any Hospice Enrollment | 4875 Participants |
Secondary
Proportion of Short-stay Residents Without Advanced Illness With Last Observed Advance Directive Status
Proportion of short-stay residents (in a NH \<90 days) who are \>=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease whose last observed advance directive status during their 100-day observation period was: Full Code, Do Not Resuscitate (NOT Do Not Hospitalize), or Do Not Hospitalize. A resident whose last observed status was both Do Not Resuscitate and Do Not Hospitalize is categorized as Do Not Hospitalize only. Analyses will be limited to Genesis HealthCare facilities in which \>75% of residents have any advance directive because the remaining Genesis HealthCare and PruittHealth facilities do not have reliable sources for these data.
Time frame: 100-day observation period
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| ACP Video Program | Proportion of Short-stay Residents Without Advanced Illness With Last Observed Advance Directive Status | Full Code | 8289 Participants |
| ACP Video Program | Proportion of Short-stay Residents Without Advanced Illness With Last Observed Advance Directive Status | Do Not Resuscitate | 4541 Participants |
| ACP Video Program | Proportion of Short-stay Residents Without Advanced Illness With Last Observed Advance Directive Status | Do Not Hospitalize | 462 Participants |
| Usual ACP Procedures | Proportion of Short-stay Residents Without Advanced Illness With Last Observed Advance Directive Status | Full Code | 12899 Participants |
| Usual ACP Procedures | Proportion of Short-stay Residents Without Advanced Illness With Last Observed Advance Directive Status | Do Not Resuscitate | 6392 Participants |
| Usual ACP Procedures | Proportion of Short-stay Residents Without Advanced Illness With Last Observed Advance Directive Status | Do Not Hospitalize | 493 Participants |
Secondary
Proportion of Target Cohort Receiving Any Burdensome Treatment
Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease who receive any burdensome treatment (new feeding tube insertions, parenteral therapy, intubation, ICU care) during a 12-month observation period
Time frame: 12-month observation period
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ACP Video Program | Proportion of Target Cohort Receiving Any Burdensome Treatment | 453 Participants |
| Usual ACP Procedures | Proportion of Target Cohort Receiving Any Burdensome Treatment | 971 Participants |
Secondary
Proportion of Target Cohort That Has Medicare ACP Billing Codes
Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease who have any Medicare ACP billing code during their 12-month observation period
Time frame: 12-month observation period
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ACP Video Program | Proportion of Target Cohort That Has Medicare ACP Billing Codes | 356 Participants |
| Usual ACP Procedures | Proportion of Target Cohort That Has Medicare ACP Billing Codes | 685 Participants |
Secondary
Proportion of Target Cohort With Any Hospice Enrollment
Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease with any hospice enrollment during a 12-month observation period
Time frame: 12-month observation period
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ACP Video Program | Proportion of Target Cohort With Any Hospice Enrollment | 904 Participants |
| Usual ACP Procedures | Proportion of Target Cohort With Any Hospice Enrollment | 1878 Participants |
Secondary
Proportion of Target Cohort With Last Observed Advance Directive Status
Proportion of long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease whose last observed advance directive status during their 12-month observation period was: Full Code, Do Not Resuscitate (NOT Do Not Hospitalize), or Do Not Hospitalize. A resident whose last observed status was both Do Not Resuscitate and Do Not Hospitalize is categorized as Do Not Hospitalize only. Analyses will be limited to Genesis HealthCare facilities in which \>75% of residents have any advance directive because the remaining Genesis HealthCare and PruittHealth facilities do not have reliable sources for these data.
Time frame: 12-month observation period
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| ACP Video Program | Proportion of Target Cohort With Last Observed Advance Directive Status | Full Code | 295 Participants |
| ACP Video Program | Proportion of Target Cohort With Last Observed Advance Directive Status | Do Not Resuscitate | 1288 Participants |
| ACP Video Program | Proportion of Target Cohort With Last Observed Advance Directive Status | Do Not Hospitalize | 387 Participants |
| Usual ACP Procedures | Proportion of Target Cohort With Last Observed Advance Directive Status | Full Code | 570 Participants |
| Usual ACP Procedures | Proportion of Target Cohort With Last Observed Advance Directive Status | Do Not Resuscitate | 2010 Participants |
| Usual ACP Procedures | Proportion of Target Cohort With Last Observed Advance Directive Status | Do Not Hospitalize | 300 Participants |