TY - JOUR
T1 - The Effect of Advance Care Planning Intervention on Hospitalization Among Nursing Home Residents
T2 - A Systematic Review and Meta-Analysis
AU - Pimsen, Apiradee
AU - Kao, Chi Yin
AU - Hsu, Sheng Tzu
AU - Shu, Bih Ching
N1 - Publisher Copyright:
© 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2022/9
Y1 - 2022/9
N2 - Objective: To evaluate the effect of advance care planning (ACP) interventions on the hospitalization of nursing home residents. Design: Systematic review and meta-analysis. Setting and Participants: Nursing homes and nursing home residents. Methods: A literature search was systematically conducted in 6 electronic databases (Embase, Ovid MEDLINE, Cochrane Library, CINAHL, AgeLine, and the Psychology & Behavioral Sciences Collection), in addition to hand searches and reference list checking; the articles retrieved were those published from 1990 to November 2021. The eligible studies were randomized controlled trials, controlled trials, and pre-post intervention studies describing original data on the effect of ACP on hospitalization of nursing home residents; these studies had to be written in English. Two independent reviewers appraised the quality of the studies and extracted the relevant data using the Joanna Briggs Institute abstraction form and critical appraisal tools. A study protocol was registered in PROSPERO (CRD42022301648). Results: The initial search yielded 744 studies. Nine studies involving a total of 57,180 residents were included in the review. The findings showed that the ACP reduced the likelihood of hospitalization [relative risk (RR) 0.54, 95% CI 0.47-0.63; I2 = 0%)], it had no effect on emergency department (ED) visits (RR 0.60, 95% CI 0.31-1.42; I2 = 99), hospice enrollment (RR 0.98, 95% CI 0.88-1.10; I2 = 0%), mortality (RR 0.83, 95% CI 0.68-1.00; I2 = 4%), and satisfaction with care (standardized mean difference: −0.04, 95% CI −0.14 to −0.06; I2 = 0%). Conclusion and Implications: ACP reduced hospitalizations but did not affect the secondary outcomes, namely, ED visits, hospice enrollment, mortality, and satisfaction with care. These findings suggest that policy makers should support the implementation of ACP programs in nursing homes. More robust studies are needed to determine the effects of ACP on ED visits, hospice enrollment, mortality, and satisfaction with care.
AB - Objective: To evaluate the effect of advance care planning (ACP) interventions on the hospitalization of nursing home residents. Design: Systematic review and meta-analysis. Setting and Participants: Nursing homes and nursing home residents. Methods: A literature search was systematically conducted in 6 electronic databases (Embase, Ovid MEDLINE, Cochrane Library, CINAHL, AgeLine, and the Psychology & Behavioral Sciences Collection), in addition to hand searches and reference list checking; the articles retrieved were those published from 1990 to November 2021. The eligible studies were randomized controlled trials, controlled trials, and pre-post intervention studies describing original data on the effect of ACP on hospitalization of nursing home residents; these studies had to be written in English. Two independent reviewers appraised the quality of the studies and extracted the relevant data using the Joanna Briggs Institute abstraction form and critical appraisal tools. A study protocol was registered in PROSPERO (CRD42022301648). Results: The initial search yielded 744 studies. Nine studies involving a total of 57,180 residents were included in the review. The findings showed that the ACP reduced the likelihood of hospitalization [relative risk (RR) 0.54, 95% CI 0.47-0.63; I2 = 0%)], it had no effect on emergency department (ED) visits (RR 0.60, 95% CI 0.31-1.42; I2 = 99), hospice enrollment (RR 0.98, 95% CI 0.88-1.10; I2 = 0%), mortality (RR 0.83, 95% CI 0.68-1.00; I2 = 4%), and satisfaction with care (standardized mean difference: −0.04, 95% CI −0.14 to −0.06; I2 = 0%). Conclusion and Implications: ACP reduced hospitalizations but did not affect the secondary outcomes, namely, ED visits, hospice enrollment, mortality, and satisfaction with care. These findings suggest that policy makers should support the implementation of ACP programs in nursing homes. More robust studies are needed to determine the effects of ACP on ED visits, hospice enrollment, mortality, and satisfaction with care.
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U2 - 10.1016/j.jamda.2022.07.017
DO - 10.1016/j.jamda.2022.07.017
M3 - Review article
C2 - 35964662
AN - SCOPUS:85136456757
SN - 1525-8610
VL - 23
SP - 1448-1460.e1
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 9
ER -
