Related Experiment Video
Updated: Sep 18, 2025
Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Care Consistency With Care Preferences in Nursing Homes: A Cluster-Randomized Study of the Effects of an Advance Care
Kornelia Götze1, Claudia Bausewein, Nadezda Chernyak
1Institute for General Practice/Family Medicine, Center for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University of Düsseldorf; Institute for General Practice/Family Medicine, Medical Faculty, University of Duisburg-Essen; Institute of Ethics, History and Theory of Medicine, LMU Munich; Department of Palliative Medicine, LMU University Hospital, Munich; Medical Faculty, Heinrich Heine University of Düsseldorf; Medical Faculty, Martin Luther University of Halle-Wittenberg, Halle (Saale); University Medical Center Göttingen; University Hospital Hamburg-Eppendorf; LMU Munich; Technical University of Applied Sciences, Rosenheim; German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN), Berlin; Faculty of Social Sciences, University of Applied Sciences Bremen; Barmer Health Insurance Fund, Wuppertal.
Background:
In this study (NCT04333303), we investigated whether a complex advance care planning (ACP) intervention improves care consistency with care preferences in nursing home residents.
Methods:
Forty-four German nursing homes were randomly assigned to an ACP intervention addressing the individual, institutional, and regional levels or to a control group (no intervention). The hospitalization rate over an observation period of 12 months (primary outcome) was analyzed as a surrogate for care consistency with care preferences at the nursing home level. Secondary outcomes comprised process-related and clinical parameters, including care consistency with care preferences (analysis level: residents/ nursing homes). Outcomes were evaluated by means of Poisson and logistic regression models with incidence rate ratios (IRR) and odds ratios (OR) as effect estimators in an intention-to-treat analysis.
Results:
Of 44 nursing homes, 23 received the intervention. The hospitalization rate did not differ between the two groups (IRR 1.0; 95% CI: [0.97; 1.1]) but declined to a similar extent in both during the COVID-19 pandemic. The consistency of care with care preferences was similar in both groups as well (OR 0.9 [0.4; 1.9]). The predefined exploratory analysis suggests that care consistency with care preferences was more likely in the 6 out of 23 nursing homes that met predefined adherence criteria (OR 1.9 [0.7; 5.3]). Written emergency plans were significantly more common in the intervention group (IRR 11.6 [8.2; 16.4]), and even more so in adherent nursing homes (IRR 30.1 [15.7; 57.6]).
Conclusion:
The intervention did not permeate sufficiently, especially due to the COVID-19 pandemic that may, in addition, have masked intrinsic shortcomings of the intervention. Thus, this trial does not allow a conclusive assessment of whether or not the intervention can promote care consistency with care preferences. However, exploratory analyses indicate that successful institutional implementation in conjunction with individual ACP conversations may increase care consistency with care preferences.
Related Concept Videos
01:29Documentation in Long-Term and Home Healthcare Setting
Long-Term Care Facilities
01:21Planning Nursing Care I
01:29Planning Nursing Care II
01:19Standards of Care II
01:15Nursing Implementation
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
01:19Restorative Care