Pragmatic Trial of Video Education in Nursing Homes
| Status: | Recruiting |
|---|---|
| Conditions: | Alzheimer Disease, Chronic Obstructive Pulmonary Disease, Cardiology, Neurology, Pulmonary |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Neurology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 65 - Any |
| Updated: | 5/17/2018 |
| Start Date: | March 2016 |
| End Date: | May 2019 |
| Contact: | Faye V Dvorchak |
| Email: | faye_dvorchak@brown.edu |
| Phone: | 401-863-2486 |
PROVEN: Pragmatic Trial of Video Education in Nursing Homes
This is a pragmatic cluster-randomized control trial (RCT) of an Advance Care Planning (ACP)
Video Program for nursing home (NH) patients ≥ 65 years old who are cared for in 360 NH
facilities (intervention arm n=119; control arm n=241) within two NH health care systems:
Genesis HealthCare and PruittHealth. The intervention NH facilities will implement the ACP
Video Program, while the control NH facilities will follow their usual ACP procedures. The
trial will evaluate the effectiveness of the ACP Video Program by comparing hospitalizations,
advance directives, and hospice use in the intervention vs. control NHs.
Video Program for nursing home (NH) patients ≥ 65 years old who are cared for in 360 NH
facilities (intervention arm n=119; control arm n=241) within two NH health care systems:
Genesis HealthCare and PruittHealth. The intervention NH facilities will implement the ACP
Video Program, while the control NH facilities will follow their usual ACP procedures. The
trial will evaluate the effectiveness of the ACP Video Program by comparing hospitalizations,
advance directives, and hospice use in the intervention vs. control NHs.
Nursing homes are complex health care systems that serve increasingly sick patients who have
advanced comorbid conditions. NHs are often charged with guiding patients through decisions
about the direction of their treatment. Patients at NHs commonly get aggressive care that may
be inconsistent with their preferences and of little clinical benefit. Identifying effective
approaches that NHs can use to better promote goal-directed care and optimize resources is a
research, public health, and clinical priority.
Advance care planning is the most consistent modifiable factor associated with better
palliative care outcomes. Traditional ACP relies on verbal descriptions of hypothetical
health states and treatments. This approach is limited because complex scenarios are
difficult to envision, counseling is inconsistent, and verbal explanations are hindered by
literacy and language barriers.
To address these shortcomings, the PROVEN project has developed video-assisted ACP
decision-support tools that have shown efficacy in small randomized controlled trials. While
several large health care systems have begun to adopt the videos, efforts have not rigorously
evaluated outcomes—a critical step prior to widespread implementation.
The goal of PROVEN is to conduct a pragmatic cluster-randomized trial to evaluate the
effectiveness of the ACP Video Program in the NH setting by partnering with 2 large health
care systems that operate 456 nursing homes nationwide. This work has the potential to
improve the care provided to millions of older Americans in nursing homes and enable future
pragmatic trials in this setting.
advanced comorbid conditions. NHs are often charged with guiding patients through decisions
about the direction of their treatment. Patients at NHs commonly get aggressive care that may
be inconsistent with their preferences and of little clinical benefit. Identifying effective
approaches that NHs can use to better promote goal-directed care and optimize resources is a
research, public health, and clinical priority.
Advance care planning is the most consistent modifiable factor associated with better
palliative care outcomes. Traditional ACP relies on verbal descriptions of hypothetical
health states and treatments. This approach is limited because complex scenarios are
difficult to envision, counseling is inconsistent, and verbal explanations are hindered by
literacy and language barriers.
To address these shortcomings, the PROVEN project has developed video-assisted ACP
decision-support tools that have shown efficacy in small randomized controlled trials. While
several large health care systems have begun to adopt the videos, efforts have not rigorously
evaluated outcomes—a critical step prior to widespread implementation.
The goal of PROVEN is to conduct a pragmatic cluster-randomized trial to evaluate the
effectiveness of the ACP Video Program in the NH setting by partnering with 2 large health
care systems that operate 456 nursing homes nationwide. This work has the potential to
improve the care provided to millions of older Americans in nursing homes and enable future
pragmatic trials in this setting.
Inclusion Criteria:
- Facilities are within Genesis HealthCare or PruittHealth health care systems
- Facilities have facility identifiers that indicate that they are
Medicare/Medicaid-certified nursing facilities in the U.S.
- Facilities serve both short and long-stay patients
- Facilities have >50 beds
- Facilities have an electronic medical records system
- Facilities had at least 20 admissions and 20 annual Minimum Data Set (MDS) assessments
(regardless of whether they were discharged alive) in 2013
Exclusion Criteria:
- Facilities excluded per corporate leaders in health care system because of recent
turnover in NH administrator or Director of Nursing
- Facilities excluded per corporate leaders in health care system because of recent bad
state or federal quality assurance survey (e.g. restriction on admissions, levied
large civil monetary penalty, etc.)
- Facilities excluded per corporate leaders in health care system because of current new
initiatives/competing demands
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