Journal of the American Medical Directors Association最新文献

{"title":"Tailored Strategies to Support Implementation of the Information System in Acute Care Setting for Older Adults Postdischarge Self-Management: A Modified Delphi Study.","authors":"Dorothy Yingxuan Wang, Eliza Lai-Yi Wong, Annie Wai-Ling Cheung, Zoe Pui-Yee Tam, Eng-Kiong Yeoh, Kam-Shing Tang","doi":"10.1016/j.jamda.2024.105262","DOIUrl":"https://doi.org/10.1016/j.jamda.2024.105262","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the Global Landscape of Exercise Interventions for Knee Osteoarthritis: Exploring Evolving Trends and Emerging Frontiers From a Bibliometric and Visualization Analysis Perspective (2011–2022)","authors":"","doi":"10.1016/j.jamda.2024.105269","DOIUrl":"10.1016/j.jamda.2024.105269","url":null,"abstract":"<div><h3>Objectives</h3><div>This study utilizes visual analysis methods to retrospectively examine the evolution and trends in exercise interventions for knee osteoarthritis (KOA) research from 2011 to 2022.</div></div><div><h3>Design</h3><div>Bibliometric and visualization analysis review.</div></div><div><h3>Setting and Participants</h3><div>Using the Web of Science database, the literature search range is from January 1, 2011, to December 31, 2022, with the language specified as English and document type set to Article.</div></div><div><h3>Methods</h3><div>Visual analysis was used to analyze literature in the field of exercise interventions for KOA, with KOA and exercise interventions as the key search terms. Visualization maps for countries/regions were created using Tableau and Scimago Graphica software. Institutional, author, and keyword visualization maps were drawn using CiteSpace and VOSviewer software.</div></div><div><h3>Results</h3><div>In total, 3137 articles were included in the visual analysis. The United States emerged as the leading country in terms of publication volume and contribution. Moreover, developed countries such as the United States, Australia, United Kingdom, and Canada have established close and stable cooperative relationships. The University of Melbourne stood out as the institution with both the highest publication volume and centrality. At the forefront of research output in this field was Bennell K.L. from the University of Melbourne. The journal with the highest co-citation frequency was <em>Osteoarthritis and Cartilage</em>. The keyword clustering map highlighted an evolution in the field of exercise interventions for KOA, emphasizing 8 key research themes spanning knee osteoarthritis, serum cartilage, osteoarthritis initiative, patellofemoral pain, total knee arthroplasty, exercise-induced hypoalgesia, isometric exercise, and anterior cruciate ligament reconstruction. Burst analysis revealed that older adult was the earliest and most prominent keyword, with contemporary topics such as patellofemoral pain, safety, musculoskeletal disorder, and neuromuscular exercise considered as research hotspots and future directions in this field.</div></div><div><h3>Conclusions and Implications</h3><div>The global attention on exercise interventions for KOA research is expanding, emphasizing the importance of strengthened connections among developing countries and collaborative author groups. Recent trends have shifted toward topics such as neuromuscular training, treatment safety, and musculoskeletal disorders, whereas research interest in patellofemoral pain remains unabated. Neuromuscular training for KOA represents the current frontier in this field. Future research should delve into the effects of diverse types of exercise interventions for KOA on neuromuscular injury and recovery, exploring feasibility and safety to formulate personalized exercise plans for patients with KOA.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability and Validity of the New Urgency Classification Model for Acute Medical Care in Dutch Nursing Home Setting","authors":"","doi":"10.1016/j.jamda.2024.105268","DOIUrl":"10.1016/j.jamda.2024.105268","url":null,"abstract":"<div><h3>Objective</h3><div>To validate an Urgency Classification Model developed for telephone triage in Dutch nursing homes.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting and Participants</h3><div>Retrospective analysis of triage data of nursing home residents in a medical service organization, active in 40 nursing homes across the Netherlands.</div></div><div><h3>Methods</h3><div>An Urgency Classification Model for nursing home care was developed through a collaborative cocreation session by modifying existing acute medical care delivery models. All inquiries to central triage personnel during regular working hours between April 1 and April 30, 2022, were retrospectively categorized according to the new Urgency Classification Model (“urgency,” consisting of 6 levels from U0 to U5; and “goals of care and treatment limitations,” consisting of 4 options) by 2 independent physicians to evaluate the reliability using Cohen's kappa. To ascertain validity, the categorized data were juxtaposed with the executed treatment plan as documented in the patient records.</div></div><div><h3>Results</h3><div>Of 387 inquiries, consensus between assessors using the Urgency Classification Model was reached upon initial independent classification of urgency in 77.0% (n = 298, Cohen's kappa 0.654) of cases and in 77.3% (n = 299, Cohen's kappa 0.649) of goals of care and treatment limitations classification, representing substantial interrater reliability. A strong positive correlation was found between the urgency identified through the Urgency Classification Model and the observed urgency in the executed treatment, r_s = 0.662, <em>P</em> &lt; .001; the same urgency was given in 71.5% (n = 276) of all inquiries. Overtriage (meaning the model classified the inquiry as more urgent than the executed treatment plan) occurred in 9.8% (n = 38) and undertriage in 18.7% (n = 72).</div></div><div><h3>Conclusion and Implications</h3><div>The new Urgency Classification Model is a valid and reliable classification tool for implementation within its intended target population. Universal and comprehensive implementation is expected to lead to more appropriate care delivery, while realizing integration with the acute medical care frameworks already in place.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives of Nursing Home Staff in Advance Care Planning Conversations: Experiences from the APPROACHES Project","authors":"","doi":"10.1016/j.jamda.2024.105265","DOIUrl":"10.1016/j.jamda.2024.105265","url":null,"abstract":"<div><h3>Objectives</h3><div>Advance care planning (ACP) is considered a best practice in the nursing home setting; however, there is a lack of consistency in the training of nursing home staff and implementation of structured ACP programs. A qualitative study interviewing ACP specialists in nursing homes was conducted to understand the experience of staff engaged in Aligning Patient Preferences – a Role offering Alzheimer's patients, Caregivers, and Healthcare providers Education and Support (APPROACHES), an embedded pragmatic clinical trial to improve ACP.</div></div><div><h3>Design</h3><div>Qualitative interviews regarding ACP specialists’ experiences and perceived intervention impact.</div></div><div><h3>Setting and Participants</h3><div>Staff of intervention-assigned nursing home facilities who completed a minimum of 10 ACP conversations with residents during APPROACHES program implementation.</div></div><div><h3>Methods</h3><div>Fourteen staff were interviewed. Interviews were transcribed and coded by the research team.</div></div><div><h3>Results</h3><div>There were 21 codes identified that were then distilled into the following 5 themes: (1) experiences with the ACP specialist program, (2) engaging in ACP conversations, (3) considerations related to dementia, (4) benefits and challenges of ACP, and (5) involvement of multiple people in the ACP process. Participant responses suggested variability in experiences with the ACP specialist program and highlighted many aspects relevant to engaging in conversations with families and residents, particularly those living with dementia. Benefits of ACP, including relationship building and increased preparedness for changes in health status, were balanced with challenges related to sensitive conversation topics and logistical difficulties in scheduling ACP discussions. ACP specialists discussed the multiple roles that others played in the ACP process.</div></div><div><h3>Conclusions and Implications</h3><div>Findings from this analysis provide insights into tailoring APPROACHES and other ACP programs for full-scale implementation in the nursing home setting. Nursing home staff experiences tailoring the program to fit their environments were reflective of the pragmatic nature of the ACP specialist program.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conception of a Recognized Accreditation for a Senior-Friendly Hospital: The Accreditation “Hospital Attentive to the Elder”","authors":"","doi":"10.1016/j.jamda.2024.105264","DOIUrl":"10.1016/j.jamda.2024.105264","url":null,"abstract":"<div><h3>Objectives</h3><div>Consideration of the need to strengthen the commitment of professionals to the good care of the older population in hospitals has been emerging over the last several years. The steering committee of the geriatric sector of the hospitals of our Hospital Consortium (HC) has structured an accreditation project to promote the commitment of professionals to the good care of older adult patients in hospitals: the “Hospital Attentive to the Elder” (HAE) accreditation. This global approach aims to better adapt care to the needs of this population in the hospital and promote positive values (eg, kindness, attentive support).</div></div><div><h3>Design</h3><div>The creation of the HAE accreditation required the creation of an accreditation board, a referential framework, and an accreditation procedure.</div></div><div><h3>Setting and Participants</h3><div>The whole process was coordinated by the accreditation board, a multidisciplinary entity, representative of the hospitals of our HC.</div></div><div><h3>Methods</h3><div>The 5-step approach of the accreditation procedure includes a commitment to the HAE, with the support of the institutional board, and an internal self-assessment phase to guide the creation of action plans, followed by an accreditation cross-evaluation visit. The HAE accreditation is awarded to departments that meet the described criteria. This accreditation process was initially initiated by our HC.</div></div><div><h3>Results</h3><div>In June 2021, 6 of 10 hospitals of our HC and 11 departments, which mobilized 28 medical, paramedical, and quality referents, initiated the process. All 11 departments fulfilled the criteria for the accreditation, and a ceremony to hand out the certificates was organized in December 2023.</div></div><div><h3>Conclusions and Implications</h3><div>We envisage that this accreditation process could be offered at the regional and national level to any hospital or group of hospitals with departments that receive patients aged &gt;75 years, regardless of their specialty.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten-Year Incidence of Sarcopenia in a Population-Based Cohort: Results from the Research on Osteoarthritis/Osteoporosis Against Disability Study","authors":"","doi":"10.1016/j.jamda.2024.105263","DOIUrl":"10.1016/j.jamda.2024.105263","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the prevalence and incidence rates of sarcopenia in Japanese community-dwelling people according to the criteria of the Asian Working Group for Sarcopenia 2019 recommendations, using a large-scale population-based cohort over a 10-year follow-up period.</div></div><div><h3>Design</h3><div>Prospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>This study was conducted using data from the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study. In total, 1551 participants (521 men and 1030 women; mean age, 65.8 years) from the second ROAD survey (2008–2-10) were included in this study.</div></div><div><h3>Methods</h3><div>The participants from the second survey were followed-up at 4, 7, and 10 years. Skeletal muscle mass, handgrip strength, and walking speed were assessed. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. The incidence of sarcopenia was calculated using the person-year method. Cox proportional hazard model was used to assess risk factors for incident sarcopenia.</div></div><div><h3>Results</h3><div>The prevalence of sarcopenia was 8.1% (8.8% in men and 7.7% in women), and the prevalence of severe sarcopenia was 2.9% (2.7% in men and 3.1% in women). The incidence rates of sarcopenia were 17.8 per 1000 and 14.5 per 1000 person-years in men and women, respectively. Additionally, the incidence rates of severe sarcopenia were 6.4 per 1000 and 4.2 per 1000 person-years in men and women, respectively. The significant risk factors for the incidence of sarcopenia were age [+1 year; hazard ratio (HR), 1.10; 95% CI, 1.08-1.12] and body mass index (−1 kg/m²; HR, 1.27; 95% CI, 1.20-1.35). The significant risk factors for the incidence of severe sarcopenia were age (+1 year; HR, 1.18; 95% CI, 1.14-1.22) and body mass index (−1 kg/m²; HR, 1.21; 95% CI, 1.10-1.33).</div></div><div><h3>Conclusions and Implications</h3><div>The prevalence and incidence rates of sarcopenia in Japan were clarified in this study.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiating Between Home Care Types to Identify Older Adults at Risk of Adverse Health Outcomes in the Community","authors":"","doi":"10.1016/j.jamda.2024.105257","DOIUrl":"10.1016/j.jamda.2024.105257","url":null,"abstract":"<div><h3>Objectives</h3><div>Acute hospitalization, recurrent admissions, institutionalization, and death are important adverse health outcomes. Older adults receiving home care are especially at risk of these outcomes, yet it remains unclear if this risk differs between older adults receiving different types of home care and older adults not receiving home care.</div></div><div><h3>Design</h3><div>Retrospective cohort study using national claims data from 2019.</div></div><div><h3>Setting and Participants</h3><div>Community-dwelling Dutch individuals aged ≥ 65 years (N = 3,174,953).</div></div><div><h3>Methods</h3><div>Participants were categorized: no home care, household help, personal care, household help combined with personal care, or nursing home care at home. The primary outcomes were the number of people experiencing acute hospitalization, recurrent admissions, institutionalization, or death. Logistic regression models were applied.</div></div><div><h3>Results</h3><div>In total, 2,758,093 adults were included in the no home care group, 131,260 in the household help group, 154,462 in the personal care group, 96,526 in the household help combined with personal care group, and 34,612 in the nursing home care at home group. The risk of adverse outcomes differed between home care groups, with all showing higher odds compared with the no home care group. Individuals receiving household help combined with personal care had the highest odds for acute hospitalization [odds ratio (OR), 2.60; 95% CI, 2.55–2.64] and recurrent admissions (OR, 2.60; 95% CI, 2.55–2.65), while those receiving nursing home care at home had the highest odds for death (OR, 7.59; 95% CI, 7.35–7.85) and institutionalization (OR, 63.22; 95% CI, 60.94–65.58).</div></div><div><h3>Conclusions and Implications</h3><div>Differentiating between the type of home care older adults receive identifies subpopulations with different risks for adverse health outcomes compared with older adults not receiving home care. Older adults receiving personal care (nurse based) are at high risk for these outcomes and represent a substantial population with prevention potential. Future research should focus on developing effective interventions for this group.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Number of Teeth and Dementia-free Life Expectancy: A 10-Year Follow-Up Study from the Japan Gerontological Evaluation Study","authors":"","doi":"10.1016/j.jamda.2024.105258","DOIUrl":"10.1016/j.jamda.2024.105258","url":null,"abstract":"<div><h3>Objectives</h3><div>Previous studies have reported that tooth loss is associated with an increased risk of dementia; however, few have explored the association between number of teeth and dementia-free and total life expectancies. We investigated whether having more teeth is associated with longer dementia-free and total life expectancies.</div></div><div><h3>Design</h3><div>A 10-year follow-up prospective cohort study from 2010 to 2020.</div></div><div><h3>Setting and Participants</h3><div>Functionally independent older adults aged ≥65 years living in 9 municipalities in Japan.</div></div><div><h3>Methods</h3><div>The exposure was the number of teeth (≥20, 10–19, 1–9, and 0). Dementia onset and mortality within the 10-year follow-up were used as the outcome. Dementia-free and total life expectancies according to the number of teeth were derived from multistate modeling estimates.</div></div><div><h3>Results</h3><div>A total of 44,083 participants were included (men: 46.8%). The mean age was 73.7 years [standard deviation (SD) = 6.0]. During follow-up, 17.3% and 21.4% of the participants experienced the onset of dementia and death, respectively. Having fewer teeth was associated with dementia [hazard ratio (HR), 1.14; 95% confidence interval (CI), 1.07–1.22, 10–19 teeth; HR, 1.15; 95% CI, 1.08–1.22, 1–9 teeth; HR, 1.13; 95% CI, 1.05–1.21, 0 teeth] and death (HR, 1.13; 95% CI, 1.05–1.22, 10–19 teeth; HR, 1.27; 95% CI, 1.19–1.37, 1–9 teeth; HR, 1.47; 95% CI, 1.36–1.59, 0 teeth) compared with having ≥20 teeth. Dementia-free life expectancies at the age of 65 years were 16.43 years and 18.88 years with ≥20 teeth, and 14.40 years and 17.12 years with 0 teeth for men and women, respectively. The total life expectancies at the age of 65 were 17.84 years and 22.03 years with ≥20 teeth, and 15.42 years and 19.79 years with 0 teeth for men and women, respectively.</div></div><div><h3>Conclusions and Implications</h3><div>Having more teeth was associated with longer dementia-free and total life expectancies.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Longitudinal Treatment Effect Analysis of Antipsychotics on Behavior of Residents in Long-Term Care","authors":"","doi":"10.1016/j.jamda.2024.105255","DOIUrl":"10.1016/j.jamda.2024.105255","url":null,"abstract":"<div><h3>Objective</h3><div>The proportion of long-term care (LTC) residents being treated with antipsychotic medication is high, and these medications may exacerbate behavioral symptoms. We used propensity scores to investigate the effect of antipsychotic use on the worsening of behavioral symptoms among residents in LTC facilities.</div></div><div><h3>Design</h3><div>A retrospective study.</div></div><div><h3>Setting and participants</h3><div>Residents in LTC in 8 provinces and 1 territory in Canada, without severe aggressive behavior at baseline and reassessed at follow-up, between March 2000 and March 2022.</div></div><div><h3>Methods</h3><div>We used propensity score matching and weighting to balance baseline covariates and logistic regression to estimate the effect of antipsychotics on the worsening of behavioral symptoms in the original, matched, and weighted cohorts. The treatment variable was use of antipsychotic medication at baseline and the outcome was worsening of behavior at follow-up.</div></div><div><h3>Results</h3><div>A total of 494,215 participants were included [318,234 women and 175,981 men; mean age 82.8 years (SD 10.1; range 18–112)].130 558 (26.4%) used antipsychotics at baseline and 88,632 (17.9%) had worsening behavior in follow-up. In the matched cohort, there were 249,698 participants, and 124,849 were matched (1:1) in each treatment group. There was a significant association between antipsychotic use at baseline and worsening in behavior at follow-up in the adjusted regression models [OR 1.27 (95% CI 1.25–1.29), &lt;0.0001] as well as in matched [OR 1.20 (95% CI 1.17–1.21), &lt;0.0001] and weighted [OR 1.26 (95% CI 1.24–1.28), &lt;0.0001] cohorts.</div></div><div><h3>Conclusions and implications</h3><div>This study further evidence to support the cautious use of antipsychotics in LTC facilities. Future research in LTC facilities could include a more granular analyses of behavior change, including bidirectional analyses between different symptom severity classifications.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Advance Care Planning in Long-Term Care and Transfers to Hospital at the End Of Life","authors":"","doi":"10.1016/j.jamda.2024.105259","DOIUrl":"10.1016/j.jamda.2024.105259","url":null,"abstract":"<div><h3>Objectives</h3><div>Our primary objective was to determine if more comprehensive advance care planning (ACP) <em>documentation</em> was associated with fewer transfers to hospital in the last year of life. Our secondary objective was to determine the impact of ACP <em>processes and practices</em> on hospital transfers in the last year of life.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Long-term care (LTC) residents in Ontario, Canada, 65 years and older who died between January 1, 2017, and May 30, 2018, and resided in a participating LTC home.</div></div><div><h3>Methods</h3><div>We administered a survey to directors of care at LTC homes inquiring about ACP practices. Our exposure of interest was living in a home with comprehensive ACP documentation that includes information beyond preferences for cardiopulmonary resuscitation and hospital transfer. Our primary outcome was the number of transfers to hospital in the last year of life. We fit negative binomial regression models to determine the independent effect of comprehensive ACP and other indicators of ACP quality.</div></div><div><h3>Results</h3><div>A total of 157 LTC homes with 6637 decedent residents were included in our study; 2942 lived in homes with comprehensive ACP documentation and 3695 had non-comprehensive ACP documents. Comprehensive documentation was not associated with fewer hospital transfers in the final year of life [incidence rat ratio (IRR), 1.00; 95% CI, 0.91–1.09]. ACP documentation update frequency, availability of ACP documents in the electronic medical record, referring to ACP documents during a health crisis, inclusion of resident values in ACP documents, and involvement of a multidisciplinary team were all associated with fewer transfers to hospital during follow-up in the last year of life.</div></div><div><h3>Conclusions and Implications</h3><div>ACP documents that contain information beyond preferences for cardiopulmonary resuscitation and hospital transfer had no association with transfers to hospital, but high-quality ACP practices and processes were associated with fewer transfers.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}