An International Perspective on Improving Physician Care in Nursing Homes

Katz, Paul R.

doi:10.1016/j.jamda.2020.01.100

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Katz et al . have noted the difficulty in convincing attending physicians to adhere to specific practice standards [ 56 ]. High quality NH care, including comprehensive ACP, requires considerably more on-site physician presence than is commonly provided [ 54 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

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BABEL (Better tArgeting, Better outcomes for frail ELderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial

et al. 2022

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Background Nursing home (NH) residents should have the opportunity to consider, discuss and document their healthcare wishes. However, such advance care planning (ACP) is frequently suboptimal. Objective Assess a comprehensive, person-centred ACP approach. Design Unblinded, cluster randomised trial. Setting Fourteen control and 15 intervention NHs in three Canadian provinces, 2018–2020. Subjects 713 residents (442 control, 271 intervention) aged ≥65 years, with elevated mortality risk. Methods The intervention was a structured, $\sim$60-min discussion between a resident, substitute decision-maker (SDM) and nursing home staff to: (i) confirm SDMs’ identities and role; (ii) prepare SDMs for medical emergencies; (iii) explain residents’ clinical condition and prognosis; (iv) ascertain residents’ preferred philosophy to guide decision-making and (v) identify residents’ preferred options for specific medical emergencies. Control NHs continued their usual ACP processes. Co-primary outcomes were: (a) comprehensiveness of advance care planning, assessed using the Audit of Advance Care Planning, and (b) Comfort Assessment in Dying. Ten secondary outcomes were assessed. P-values were adjusted for all 12 outcomes using the false discovery rate method. Results The intervention resulted in 5.21-fold higher odds of respondents rating ACP comprehensiveness as being better (95% confidence interval [CI] 3.53, 7.61). Comfort in dying did not differ (difference = −0.61; 95% CI −2.2, 1.0). Among the secondary outcomes, antimicrobial use was significantly lower in intervention homes (rate ratio = 0.79, 95% CI 0.66, 0.94). Conclusions Superior comprehensiveness of the BABEL approach to ACP underscores the importance of allowing adequate time to address all important aspects of ACP and may reduce unwanted interventions towards the end of life.

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Section: Discussionmentioning

confidence: 99%

“…High quality NH care, including comprehensive ACP, requires considerably more on-site physician presence than is commonly provided [ 54 , 57 ]. And it has been suggested to make NH medicine a specialty with required training, board examinations and closed-model, full-time, salaried, on-site positions [ 54 , 56 ].…”

Section: Discussionmentioning

confidence: 99%