Journal of the American Medical Directors Association
Original StudyIntroducing Goals of Patient Care in Residential Aged Care Facilities to Decrease Hospitalization: A Cluster Randomized Controlled Trial
Section snippets
Goals of Patient Care
The GOPC form (Appendix 1) is a document used to record medical treatment plans for residents of RACF in the event of clinical deterioration. It considers the current medical condition as well as the residents' preferences and any prior advance care planning. As it is specifically for RACF residents, it identifies whether residents are open to hospital transfer for treatment escalation. The form is completed by a medical physician with the resident or their substitute medical decision maker, or
Study Design
The study design was an unblinded prospective cluster randomized controlled trial evaluating the effects of the implementation of the GOPC medical treatment orders for RACF residents. The clusters were defined as the individual RACF, which were then organized into cluster pairs and randomized. Clustering was used to prevent cross-contamination between sites influencing the results. Written informed consent was obtained for RACF participation and to gain access to the local health care services
Participants
The residents from the 3 Intervention RACFs were combined for analysis, as were the residents from the 3 Control RACFs. The total potential study population was 445 residents, with 418 fitting inclusion criteria and 326 continuing to randomization. In the 6 RACFs involved, the mean study participation rate was 78%. In total, at study commencement, there were 145 residents in the Control Group and 181 in the Intervention Group.
The CONSORT participant flow diagram indicates the number of
Discussion
The GOPC intervention was found to be superior to advance care planning documents alone in the RACF population with regard to preventing ED visits and emergency admissions 12 months post implementation, aligning with previous studies examining medical treatment orders.29, 30 High hospitalization rates of RACF residents have detrimental effects on residents' quality of life as well as economic consequences for health services, and so interventions to decrease these rates are important for all
Conclusions and Implications
In RACFs in Australia, GOPC medical treatment orders had a positive effect on the hospitalization rates and preferred place of death of RACF residents without increasing mortality. The implications of this are that RACF and health services would benefit from GOPC being introduced to improve resident outcomes. In Victoria, new legislation allows only those with decision-making capacity to complete advance care plans, no longer allowing substitute medical decision makers to complete them on their
Acknowledgements
The authors acknowledge Northern Health Foundation for a Small Research Grant for the study, and the Northern Health Aged Care Research Department and the University of Melbourne for research scholarships for the principal researcher. There were no study sponsors further to these grants. The researchers are independent from the funders.
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The authors declare no conflicts of interest.