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Provider staffing effect on a decision aid intervention
Mary Ersek1, Justine S Sefcik, Feng-Chang Lin
1Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
Clinical Nursing Research
|January 8, 2013
Summary
A decision aid improved surrogate discussions about feeding options in dementia care, especially when Nurse Practitioners (NPs) and Physician Assistants (PAs) were not full-time. Full-time NP/PA staffing also supported better decision-making.
Area of Science:
- Gerontology
- Health Services Research
- Clinical Decision Support
Background:
- Effective surrogate decision-making is crucial for individuals with dementia in nursing homes.
- The roles of advanced practice providers like Nurse Practitioners (NPs) and Physician Assistants (PAs) in facilitating these discussions are not fully understood.
- Decision aids can support surrogates, but their effectiveness may vary based on staffing models.
Purpose of the Study:
- To investigate the impact of Nurse Practitioner (NP) and Physician Assistant (PA) staffing levels on surrogate decision-making in nursing homes.
- To evaluate the effectiveness of a decision aid for feeding options in dementia on surrogate-provider discussions and decisional conflict.
- To determine if NP/PA staffing modifies the effect of the decision aid.
Main Methods:
- A comparative study involving 256 surrogate decision-makers across 24 nursing homes.
- Nursing homes were categorized by NP/PA staffing: none, part-time, or full-time.
- Outcomes measured included the frequency of surrogate-provider discussions and surrogate decisional conflict, comparing intervention (decision aid) and control groups.
Main Results:
- The decision aid significantly increased discussion rates in facilities with no or part-time NP/PA staffing (from 13% to 41% and 26% to 51%, respectively).
- The decision aid significantly decreased decisional conflict scores in facilities with no or part-time NP/PA staffing.
- Facilities with full-time NP/PA staffing demonstrated high baseline discussion rates (41%) and were not significantly impacted by the decision aid.
Conclusions:
- Both the decision aid and full-time NP/PA staffing can enhance surrogate decision-making processes in nursing home settings.
- The decision aid is particularly beneficial in facilities with limited or no NP/PA presence.
- Optimizing staffing models and utilizing decision support tools can improve care quality for nursing home residents with dementia.
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