Kornelia Götze, Claudia Bausewein, Nadezda Chernyak, Berend Feddersen, Angela Fuchs, Eva Hummers, Andrea Icks, Änne Kirchner, Stephanie Klosterhalfen, Nicola Kranefeld, Sonja Laag, Susanne Lezius, Gabriele Meyer, Joseph Montalbo, Friedemann Nauck, Amra Pepić, Susanne Przybylla, Irina Rosu, Jan Schildmann, Michaela Schunk, Henrikje Stanze, Andreas Stöhr, Nancy Thilo, Christiane Vogel, Antonia Zapf, Georg Marckmann, Jürgen in der Schmitten
{"title":"护理一致性与养老院护理偏好：一项预先护理计划程序（BEVOR）效果的集群随机研究。","authors":"Kornelia Götze, Claudia Bausewein, Nadezda Chernyak, Berend Feddersen, Angela Fuchs, Eva Hummers, Andrea Icks, Änne Kirchner, Stephanie Klosterhalfen, Nicola Kranefeld, Sonja Laag, Susanne Lezius, Gabriele Meyer, Joseph Montalbo, Friedemann Nauck, Amra Pepić, Susanne Przybylla, Irina Rosu, Jan Schildmann, Michaela Schunk, Henrikje Stanze, Andreas Stöhr, Nancy Thilo, Christiane Vogel, Antonia Zapf, Georg Marckmann, Jürgen in der Schmitten","doi":"10.3238/arztebl.m2025.0077","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In this study (NCT04333303), we investigated whether a complex advance care planning (ACP) intervention improves care consistency with care preferences in nursing home residents.</p><p><strong>Methods: </strong>Forty-four German nursing homes were randomly assigned to an ACP intervention addressing the individual, institutional, and regional levels or to a control group (no intervention). The hospitalization rate over an observation period of 12 months (primary outcome) was analyzed as a surrogate for care consistency with care preferences at the nursing home level. Secondary outcomes comprised process-related and clinical parameters, including care consistency with care preferences (analysis level: residents/ nursing homes). Outcomes were evaluated by means of Poisson and logistic regression models with incidence rate ratios (IRR) and odds ratios (OR) as effect estimators in an intention-to-treat analysis.</p><p><strong>Results: </strong>Of 44 nursing homes, 23 received the intervention. The hospitalization rate did not differ between the two groups (IRR 1.0; 95% CI: [0.97; 1.1]) but declined to a similar extent in both during the COVID-19 pandemic. The consistency of care with care preferences was similar in both groups as well (OR 0.9 [0.4; 1.9]). The predefined exploratory analysis suggests that care consistency with care preferences was more likely in the 6 out of 23 nursing homes that met predefined adherence criteria (OR 1.9 [0.7; 5.3]). Written emergency plans were significantly more common in the intervention group (IRR 11.6 [8.2; 16.4]), and even more so in adherent nursing homes (IRR 30.1 [15.7; 57.6]).</p><p><strong>Conclusion: </strong>The intervention did not permeate sufficiently, especially due to the COVID-19 pandemic that may, in addition, have masked intrinsic shortcomings of the intervention. Thus, this trial does not allow a conclusive assessment of whether or not the intervention can promote care consistency with care preferences. However, exploratory analyses indicate that successful institutional implementation in conjunction with individual ACP conversations may increase care consistency with care preferences.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"379-386"},"PeriodicalIF":7.1000,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Care Consistency With Care Preferences in Nursing Homes: A Cluster-Randomized Study of the Effects of an Advance Care Planning Program (BEVOR).\",\"authors\":\"Kornelia Götze, Claudia Bausewein, Nadezda Chernyak, Berend Feddersen, Angela Fuchs, Eva Hummers, Andrea Icks, Änne Kirchner, Stephanie Klosterhalfen, Nicola Kranefeld, Sonja Laag, Susanne Lezius, Gabriele Meyer, Joseph Montalbo, Friedemann Nauck, Amra Pepić, Susanne Przybylla, Irina Rosu, Jan Schildmann, Michaela Schunk, Henrikje Stanze, Andreas Stöhr, Nancy Thilo, Christiane Vogel, Antonia Zapf, Georg Marckmann, Jürgen in der Schmitten\",\"doi\":\"10.3238/arztebl.m2025.0077\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In this study (NCT04333303), we investigated whether a complex advance care planning (ACP) intervention improves care consistency with care preferences in nursing home residents.</p><p><strong>Methods: </strong>Forty-four German nursing homes were randomly assigned to an ACP intervention addressing the individual, institutional, and regional levels or to a control group (no intervention). The hospitalization rate over an observation period of 12 months (primary outcome) was analyzed as a surrogate for care consistency with care preferences at the nursing home level. Secondary outcomes comprised process-related and clinical parameters, including care consistency with care preferences (analysis level: residents/ nursing homes). Outcomes were evaluated by means of Poisson and logistic regression models with incidence rate ratios (IRR) and odds ratios (OR) as effect estimators in an intention-to-treat analysis.</p><p><strong>Results: </strong>Of 44 nursing homes, 23 received the intervention. The hospitalization rate did not differ between the two groups (IRR 1.0; 95% CI: [0.97; 1.1]) but declined to a similar extent in both during the COVID-19 pandemic. The consistency of care with care preferences was similar in both groups as well (OR 0.9 [0.4; 1.9]). 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Care Consistency With Care Preferences in Nursing Homes: A Cluster-Randomized Study of the Effects of an Advance Care Planning Program (BEVOR).
Background: In this study (NCT04333303), we investigated whether a complex advance care planning (ACP) intervention improves care consistency with care preferences in nursing home residents.
Methods: Forty-four German nursing homes were randomly assigned to an ACP intervention addressing the individual, institutional, and regional levels or to a control group (no intervention). The hospitalization rate over an observation period of 12 months (primary outcome) was analyzed as a surrogate for care consistency with care preferences at the nursing home level. Secondary outcomes comprised process-related and clinical parameters, including care consistency with care preferences (analysis level: residents/ nursing homes). Outcomes were evaluated by means of Poisson and logistic regression models with incidence rate ratios (IRR) and odds ratios (OR) as effect estimators in an intention-to-treat analysis.
Results: Of 44 nursing homes, 23 received the intervention. The hospitalization rate did not differ between the two groups (IRR 1.0; 95% CI: [0.97; 1.1]) but declined to a similar extent in both during the COVID-19 pandemic. The consistency of care with care preferences was similar in both groups as well (OR 0.9 [0.4; 1.9]). The predefined exploratory analysis suggests that care consistency with care preferences was more likely in the 6 out of 23 nursing homes that met predefined adherence criteria (OR 1.9 [0.7; 5.3]). Written emergency plans were significantly more common in the intervention group (IRR 11.6 [8.2; 16.4]), and even more so in adherent nursing homes (IRR 30.1 [15.7; 57.6]).
Conclusion: The intervention did not permeate sufficiently, especially due to the COVID-19 pandemic that may, in addition, have masked intrinsic shortcomings of the intervention. Thus, this trial does not allow a conclusive assessment of whether or not the intervention can promote care consistency with care preferences. However, exploratory analyses indicate that successful institutional implementation in conjunction with individual ACP conversations may increase care consistency with care preferences.
期刊介绍：
Deutsches Ärzteblatt International is a bilingual (German and English) weekly online journal that focuses on clinical medicine and public health. It serves as the official publication for both the German Medical Association and the National Association of Statutory Health Insurance Physicians. The journal is dedicated to publishing independent, peer-reviewed articles that cover a wide range of clinical medicine disciplines. It also features editorials and a dedicated section for scientific discussion, known as correspondence.
The journal aims to provide valuable medical information to its international readership and offers insights into the German medical landscape. Since its launch in January 2008, Deutsches Ärzteblatt International has been recognized and included in several prestigious databases, which helps to ensure its content is accessible and credible to the global medical community. These databases include:
Carelit
CINAHL (Cumulative Index to Nursing and Allied Health Literature)
Compendex
DOAJ (Directory of Open Access Journals)
EMBASE (Excerpta Medica database)
EMNursing
GEOBASE (Geoscience & Environmental Data)
HINARI (Health InterNetwork Access to Research Initiative)
Index Copernicus
Medline (MEDLARS Online)
Medpilot
PsycINFO (Psychological Information Database)
Science Citation Index Expanded
Scopus
By being indexed in these databases, Deutsches Ärzteblatt International's articles are made available to researchers, clinicians, and healthcare professionals worldwide, contributing to the global exchange of medical knowledge and research.
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