Introducing Goals of Patient Care in Residential Aged Care Facilities to Decrease Hospitalization: A Cluster...

Area of Science:

• Geriatric Medicine
• Palliative Care
• Health Services Research

Background:

• Advance care planning (ACP) is crucial for guiding medical decisions in aged care.
• The Goals of Patient Care (GOPC) process integrates resident preferences into medical orders.
• Effectiveness of GOPC compared to ACP alone needs evaluation.

Purpose of the Study:

• To determine if GOPC medical orders are more effective than ACP alone.
• To assess GOPC's impact on preventing emergency department (ED) visits and hospitalizations.
• To evaluate GOPC's effect on mortality outside the residential aged care facility (RACF).

Main Methods:

• Prospective cluster randomized controlled trial.
• Intervention: GOPC process completion by a geriatrician using shared decision-making.
• Setting: 6 RACFs in Melbourne, Australia; included permanent residents with consent.

Main Results:

• At 12 months, GOPC significantly reduced ED visits and hospitalizations by 40% (IRR 0.63).
• No significant change observed at 6 months.
• Increased likelihood of in-RACF mortality at 6 months (RR 2.19).

Conclusions:

• GOPC medical treatment orders are more effective than ACP alone in RACF populations.
• GOPC reduces hospitalizations and deaths outside the RACF.
• RACF staff and health services should consider implementing GOPC.