UH3 Project: Pragmatic Trial of Video Education in Nursing Homes (PROVEN)

UH3 Project: Pragmatic Trial of Video Education in Nursing Homes (PROVEN)

Principal Investigators:

Sponsoring Institution: Brown University School of Public Health

NIH Institute Providing Oversight: National Institute on Aging (NIA)

Program Official: Marcel Salive, MD, MPH (NIA)

Project Scientist: Jeri Miller, PhD (National Institute of Nursing Research [NINR])

ClinicalTrials.gov Identifier: NCT02612688

Locations: Nursing homes in Genesis HealthCare and PruittHealth healthcare systems

Trial Status: Completed

Study Snapshot

Trial Summary

Study question and significance: Nursing homes are often charged with guiding patients through decisions about the direction of their treatment. Identifying effective approaches that nursing homes can use to better promote goal-directed care within existing resources is a research, public health, and clinical priority. Yet, evidenced-based approaches to advance care planning in nursing homes are lacking. The objective of PROVEN was to test the effect of an advance care planning video program on hospital transfers, burdensome treatments, and hospice enrollment among long-stay nursing home residents.

Design and setting: Cluster randomized trial with 197,692 residents in 360 nursing homes in 32 states owned by 2 for-profit corporations, of which 241 facilities were randomly assigned to the control group and 119 facilities were randomly assigned to the intervention.

Intervention and methods: The intervention involved 5 short advance care planning videos made available on tablet computers or online. Designated champions in the intervention facilities were instructed to offer residents or their proxies the opportunity to view a video on admission and every 6 months. Control facilities used usual advance care planning practices. The primary outcome was hospital transfers per 1000 person- days alive among residents with advanced illness. Secondary outcomes included the proportion of residents with or without advanced illness experiencing 1 or more hospital transfer, 1 or more burdensome treatment, and hospice enrollment. The analyses followed the intention-to-treat principle.

Findings: There was no significant reduction in hospital transfers per 1000 person-days alive in the intervention vs control groups. Secondary outcomes did not significantly differ between groups among residents with and without advanced illness. Only 912 of 4171 residents with advanced illness viewed the advance care planning videos. Facility-level rates of showing the videos ranged from 0% to more than 40%.

Conclusions and relevance: The advance care planning video program was not effective in reducing hospital transfers, decreasing burdensome treatment use, or increasing hospice enrollment among long-stay nursing home residents with or without advanced illness. The low level of intervention fidelity highlights the challenges of implementing new programs in nursing homes.

NIH Project Information

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Dr. Mitchell presents findings from the PROVEN Trial, an NIH Collaboratory Trial that studied the effect of showing advance care planning videos to long-stay nursing home residents.

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