Effect of an Advance Care Planning Intervention

Study Overview
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Brief Summary
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The intervention being studied is an advance care planning intervention. The trial has two arms: usual care and information arm.

Detailed Description
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Eligible patients whose assisted living centers are randomized to the information arm will receive a letter from their clinician with links to informational video. Eligible patients whose assisted living centers are randomized to the usual care arm have advance care planning discussions with a clinician at admission, annually, and sometimes with a hospitalization or other change in condition.

Official Title
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Effect of an Advance Care Planning Intervention on Documentation of Advance Directives and Goals of Care in Assisted Living Centers

Conditions
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Dementia

Intervention / Treatment
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* Behavioral: Advance Care Planning Video


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Partnering assisted living center with at least 20 patients with a dementia diagnosis (based on International Classification of Diseases, version 10 codes) Patients not on hospice Patients who do not have comfort care or do-not-hospitalize orders at baseline Exclusion Criteria: Partnering assisted living center with less than 20 patients with a dementia diagnosis (based on International Classification of Diseases, version 10 codes) Patients on hospice Patients with comfort care or do-not-hospitalize orders at baseline
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual Care<br>Patients and proxies in assisted living centers randomized to the usual care arm have advance care planning discussions with a clinician at admission, annually, and sometimes with a hospitalization or other change in condition. There is no standardized decision- or conversation-support tools used to have these discussions. | |
| Experimental: Information<br>Patients and proxies in assisted living centers randomized to the information arm will receive a letter from their clinician with a link to an educational video describing the goals of care and how specific treatment decisions align with these goals. Patients and proxies will also continue to receive usual care advance care planning conversations. | Behavioral: Advance Care Planning Video<br>* Clinical assistants determine who is the correct person to receive the informational materials. If the patient is the correct recipient, clinicians will send the informational materials to the patient at the assisted living center. If the proxy is the correct recipient, the clinical assistant will determine whether or not the proxy is using the existing online portal. If the proxy is using the portal, the informational materials will be sent electronically. If the proxy does not access the portal, the informational materials will be sent to their residences.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Do-Not-Resuscitate | Percentage of residents with do-not-resuscitate orders documented in the electronic health record at end of follow-up, comparison between usual care and experimental arm | 4 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Do-Not-Hospitalize | Percentage of residents in each arm with do-not-hospitalize or comfort care orders documented in the electronic health record at end of follow-up, comparison between usual care and experimental arm | 4 months | 
| Advance Care Planning Billing | Percentage of residents in each arm with current procedural terminology billing code for advance care planning during follow-up based on Medicare claims data, comparison between usual care and experimental arm. Requires access to claims data which delays reporting | 4 months | 
| Hospitalization | Percentage of residents with any inpatient hospitalization during follow-up based on Medicare claims data, comparison between usual care and experimental arm. Requires access to claims data which delays reporting | 4 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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assisted living facilities, dementia, advance care planning