Effectiveness of a complex regional advance care planning intervention to improve care consistency with care preferences
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Effectiveness of a complex regional advance care planning intervention to improve care consistency with care preferences. / Götze, Kornelia; Bausewein, Claudia; Feddersen, Behrend; Fuchs, Angela; Hot, Amra; Hummers, Eva; Icks, Andrea; Kirchner, Änne; Kleinert, Evelyn; Klosterhalfen, Stephanie; Kolbe, Henrike; Laag, Sonja; Langner, Henriette; Lezius, Susanne; Meyer, Gabriele; Montalbo, Joseph; Nauck, Friedemann; Reisinger, Christine; Rieder, Nicola; Schildmann, Jan; Schunk, Michaela; Stanze, Henrikje; Vogel, Christiane; Wegscheider, Karl; Zapf, Antonia; Marckmann, Georg; in der Schmitten, Jürgen; BEVOR study group.
In: TRIALS, Vol. 23, No. 1, 770, 12.09.2022.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Effectiveness of a complex regional advance care planning intervention to improve care consistency with care preferences
AU - Götze, Kornelia
AU - Bausewein, Claudia
AU - Feddersen, Behrend
AU - Fuchs, Angela
AU - Hot, Amra
AU - Hummers, Eva
AU - Icks, Andrea
AU - Kirchner, Änne
AU - Kleinert, Evelyn
AU - Klosterhalfen, Stephanie
AU - Kolbe, Henrike
AU - Laag, Sonja
AU - Langner, Henriette
AU - Lezius, Susanne
AU - Meyer, Gabriele
AU - Montalbo, Joseph
AU - Nauck, Friedemann
AU - Reisinger, Christine
AU - Rieder, Nicola
AU - Schildmann, Jan
AU - Schunk, Michaela
AU - Stanze, Henrikje
AU - Vogel, Christiane
AU - Wegscheider, Karl
AU - Zapf, Antonia
AU - Marckmann, Georg
AU - in der Schmitten, Jürgen
AU - BEVOR study group
PY - 2022/9/12
Y1 - 2022/9/12
N2 - BackgroundAccording to recent legislation, facilitated advance care planning (ACP) for nursing home (NH) residents is covered by German sickness funds. However, the effects of ACP on patient-relevant outcomes have not been studied in Germany yet. This study investigates whether implementing a complex regional ACP intervention improves care consistency with care preferences in NH residents.MethodsThis is a parallel-group cluster-randomized controlled trial (cRCT) with 48 NHs (≈ 3840 resident beds) between 09/2019 and 02/2023. The intervention group will receive a complex, regional ACP intervention aiming at sustainable systems redesign at all levels (individual, institutional, regional). The intervention comprises comprehensive training of ACP facilitators, implementation of reliable ACP processes, organizational development in the NH and other relevant institutions of the regional healthcare system, and education of health professionals caring for the residents. Control group NHs will deliver care as usual.Primary outcome is the hospitalization rate during the 12-months observation period. Secondary outcomes include the rate of residents whose preferences were known and honored in potentially life-threatening events, hospital days, index treatments like resuscitation and artificial ventilation, advance directives, quality of life, psychological burden on bereaved families, and costs of care.The NHs will provide anonymous, aggregated data of all their residents on the primary outcome and several secondary outcomes (data collection 1). For residents who have given informed consent, we will evaluate care consistency with care preferences and further secondary outcomes, based on chart reviews and short interviews with residents, surrogates, and carers (data collection 2). Process evaluation will aim to explain barriers and facilitators, economic evaluation the cost implications.DiscussionThis study has the potential for high-quality evidence on the effects of a complex regional ACP intervention on NH residents, their families and surrogates, NH staff, and health care utilization in Germany. It is the first cRCT investigating a comprehensive regional ACP intervention that aims at improving patient-relevant clinical outcomes, addressing and educating multiple institutions and health care providers, besides qualification of ACP facilitators. Thereby, it can generate evidence on the potential of ACP to effectively promote patient-centered care in the vulnerable population of frail and often chronically ill elderly.Trial registrationClinicalTrials.gov ID NCT04333303. Registered 30 March 2020.
AB - BackgroundAccording to recent legislation, facilitated advance care planning (ACP) for nursing home (NH) residents is covered by German sickness funds. However, the effects of ACP on patient-relevant outcomes have not been studied in Germany yet. This study investigates whether implementing a complex regional ACP intervention improves care consistency with care preferences in NH residents.MethodsThis is a parallel-group cluster-randomized controlled trial (cRCT) with 48 NHs (≈ 3840 resident beds) between 09/2019 and 02/2023. The intervention group will receive a complex, regional ACP intervention aiming at sustainable systems redesign at all levels (individual, institutional, regional). The intervention comprises comprehensive training of ACP facilitators, implementation of reliable ACP processes, organizational development in the NH and other relevant institutions of the regional healthcare system, and education of health professionals caring for the residents. Control group NHs will deliver care as usual.Primary outcome is the hospitalization rate during the 12-months observation period. Secondary outcomes include the rate of residents whose preferences were known and honored in potentially life-threatening events, hospital days, index treatments like resuscitation and artificial ventilation, advance directives, quality of life, psychological burden on bereaved families, and costs of care.The NHs will provide anonymous, aggregated data of all their residents on the primary outcome and several secondary outcomes (data collection 1). For residents who have given informed consent, we will evaluate care consistency with care preferences and further secondary outcomes, based on chart reviews and short interviews with residents, surrogates, and carers (data collection 2). Process evaluation will aim to explain barriers and facilitators, economic evaluation the cost implications.DiscussionThis study has the potential for high-quality evidence on the effects of a complex regional ACP intervention on NH residents, their families and surrogates, NH staff, and health care utilization in Germany. It is the first cRCT investigating a comprehensive regional ACP intervention that aims at improving patient-relevant clinical outcomes, addressing and educating multiple institutions and health care providers, besides qualification of ACP facilitators. Thereby, it can generate evidence on the potential of ACP to effectively promote patient-centered care in the vulnerable population of frail and often chronically ill elderly.Trial registrationClinicalTrials.gov ID NCT04333303. Registered 30 March 2020.
KW - Advance Care Planning
KW - Aged
KW - Germany
KW - Health Personnel
KW - Humans
KW - Multicenter Studies as Topic
KW - Nursing Homes
KW - Quality of Life
KW - Randomized Controlled Trials as Topic
U2 - 10.1186/s13063-022-06576-3
DO - 10.1186/s13063-022-06576-3
M3 - SCORING: Journal article
C2 - 36096948
VL - 23
JO - TRIALS
JF - TRIALS
SN - 1745-6215
IS - 1
M1 - 770
ER -