{"id":20449,"date":"2024-09-11T08:47:58","date_gmt":"2024-09-11T12:47:58","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=20449"},"modified":"2024-09-25T09:01:53","modified_gmt":"2024-09-25T13:01:53","slug":"quality-of-advance-care-planning-in-long-term-care-and-transfers-to-hospital-at-the-end-of-life","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/quality-of-advance-care-planning-in-long-term-care-and-transfers-to-hospital-at-the-end-of-life\/","title":{"rendered":"Quality of advance care planning in long term care and transfers to hospital at the end-of-life"},"content":{"rendered":"<p><strong>Objectives<\/strong>\u00a0\u2014\u00a0Our primary objective was to determine if more comprehensive advance care planning (ACP) documentation was associated with fewer transfers to hospital in the last year of life. Our secondary objective was to determine the impact of ACP processes and practices on hospital transfers in the last year of life.<\/p>\n<p><strong>Design\u00a0<\/strong>\u2014\u00a0Retrospective cohort study.<\/p>\n<p><strong>Setting and participants\u00a0<\/strong>\u2014\u00a0Long-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.<\/p>\n<p><strong>Methods\u00a0<\/strong>\u2014\u00a0We 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.<\/p>\n<p><strong>Results\u00a0<\/strong>\u2014\u00a0A 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.<\/p>\n<p><strong>Conclusions and implications<\/strong>\u00a0\u2014\u00a0ACP 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.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Objectives\u00a0\u2014\u00a0Our primary objective was to determine if more comprehensive advance care planning (ACP) documentation was associated with fewer transfers to hospital in the last year of life. Our secondary objective was to determine the impact of ACP processes and practices on hospital transfers in the last year of life. Design\u00a0\u2014\u00a0Retrospective cohort study. Setting and participants\u00a0\u2014\u00a0Long-term [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[33,62,32],"migration-helper-qa-sample-set":[],"class_list":["post-20449","journal_article","type-journal_article","status-publish","hentry","topic-end-of-life-care","topic-health-services-research","topic-long-term-care-and-continuing-care"],"acf":{"citation":"Turcotte L, Scott MM, Petrcich W, Tanuseputro P, Kobewka D. <em>J Am Med Dir Assoc<\/em>. 2024; 105259. Epub 2024 Sep 11.","source_url":"https:\/\/doi.org\/10.1016\/j.jamda.2024.105259","ices_scientist":[1107,1141],"site":[6734],"research_program":[6745],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Quality of advance care planning in long term care and transfers to hospital at the end-of-life<\/title>\n<meta name=\"description\" content=\"Objectives\u00a0\u2014\u00a0Our primary objective was to determine if more comprehensive advance care planning (ACP) documentation was associated with fewer transfers to\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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