Sustaining Prevention of Error-based Transfers (PoET) Project: a 1-year follow-up evaluation of the PoET Southwest Spread Project

Objectives — To evaluate the 12-month impact of the Prevention of Error–Based Transfers Southwest Spread Project (PSSP), an intervention designed to align long-term care (LTC) health care decision-making with Ontario’s Health Care Consent Act, on acute care transfers, palliative care encounters, and health care system costs.

Design — Quasi-experimental matched cohort study.

Setting and participants — A total of 4103 and 4791 Ontario LTC residents aged 19 years and older from 30 PSSP LTC homes and 30 matched control LTC homes, respectively, were included in this analysis.

Methods — Linked ICES (formerly known as the Institute for Clinical Evaluative Sciences) health administrative data were used to reassess 12-month outcomes using methods consistent with previously published 6-month analyses. Primary outcomes were acute care transfers and physician palliative care encounters; secondary outcomes were health care system costs estimated using the GETCOST methodology. Analyses employed generalized linear mixed models accounting for clustering within matched LTC homes.

Results — At 12 months, PSSP homes continued to show fewer acute care transfers in both overall and decedent cohorts (19.9% and 21.7% vs 27% and 45%, respectively, at 6 months). Physician palliative care encounters showed a sustained increase for the overall cohort (160% vs 147% at 6 months). Health care costs were lower in PSSP homes by $289/resident and $316/resident annually in our overall and decedent cohort, respectively.

Conclusions and implications — Improvements associated with initial Prevention of Error-based Transfers implementation persisted at 12 months, but with partial attenuation for acute transfer reductions. Together with the sustained gains in palliative care and newly observed cost savings, these findings support ongoing investment in consent-aligned decision-making practices in LTC.