An advance directive programme in nursing homes reduced health services use without affecting patient satisfaction
QUESTION: Does systematic implementation of an advance directive programme in nursing homes affect patient and family satisfaction and reduce healthcare costs?
Design
Randomised {allocation concealed}*, blinded {residents}*, controlled trial with 18 months of follow up.
Setting
6 nursing homes in Ontario, Canada, each with >100 residents.
Patients
1292 nursing home residents.
Intervention
6 nursing homes were matched in pairs on key characteristics and randomised 1 home per pair to either an advance directive programme (3 intervention homes, 636 patients) or to continue with usual policies of advance directives (3 control homes, 656 patients). The intervention homes used an advance directive programme called Let Me Decide (LMD), which consisted of healthcare choices related to life threatening illness, cardiac arrest, and nutrition. The LMD advance …
