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Systematic implementation of an advance directive program in nursing homes: a randomized controlled trial.
D W Molloy1, G H Guyatt, R Russo
1Department of Medicine, McMaster University, Ontario, Canada. molloy@mcmaster.ca
JAMA
|March 25, 2000
Summary
Systematically implementing advance directives in nursing homes reduced hospitalizations and healthcare costs. Patient and family satisfaction with decision-making and mortality rates remained unaffected by this program.
Area of Science:
- Gerontology
- Health Services Research
- Bioethics
Background:
- Advance directives are widely used but their systematic implementation effects are understudied.
- Nursing home residents often have complex health needs requiring clear end-of-life care plans.
Purpose of the Study:
- To evaluate the impact of a systematically implemented advance directive program in nursing homes.
- To assess effects on patient and family satisfaction with decision-making and healthcare costs.
Main Methods:
- A randomized controlled trial was conducted in 6 Ontario nursing homes over 4 years.
- The intervention involved educating staff, residents, and families about advance directives.
- Comparison was made between intervention and control nursing homes regarding satisfaction and resource utilization.
Main Results:
- Systematic advance directive implementation led to significantly fewer hospitalizations and lower average healthcare costs.
- No significant differences were observed in patient or family satisfaction levels between groups.
- Mortality rates were similar in both intervention and control nursing homes.
Conclusions:
- Systematic advance directive programs can reduce healthcare utilization in nursing homes.
- These programs do not negatively impact patient/family satisfaction or mortality.
- This approach offers a viable strategy for improving end-of-life care planning in long-term care settings.
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