Cargando…
Implementation of ‘Goals of Patient Care’ medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial
INTRODUCTION: Systematic reviews demonstrate that advance care planning (ACP) has many positive effects for residents of aged care facilities, including decreased hospitalisation. The proposed Residential Aged Care Facility (RACF) ‘Goals of Patient Care’ (GOPC) form incorporates a resident's pr...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353337/ https://www.ncbi.nlm.nih.gov/pubmed/28283490 http://dx.doi.org/10.1136/bmjopen-2016-013909 |
_version_ | 1782515094575382528 |
---|---|
author | Martin, Ruth S Hayes, Barbara J Hutchinson, Anastasia Yates, Paul Lim, Wen Kwang |
author_facet | Martin, Ruth S Hayes, Barbara J Hutchinson, Anastasia Yates, Paul Lim, Wen Kwang |
author_sort | Martin, Ruth S |
collection | PubMed |
description | INTRODUCTION: Systematic reviews demonstrate that advance care planning (ACP) has many positive effects for residents of aged care facilities, including decreased hospitalisation. The proposed Residential Aged Care Facility (RACF) ‘Goals of Patient Care’ (GOPC) form incorporates a resident's prior advance care plan into medical treatment orders. Where none exists, it captures residents' preferences. This documentation helps guide healthcare decisions made at times of acute clinical deterioration. METHODS AND ANALYSIS: This is a mixed methods study. An unblinded cluster randomised controlled trial is proposed in three pairs of RACFs. In the intervention arm, GOPC forms will be completed by a doctor incorporating advance care plans or wishes. In the control arm, residents will have usual care which may include an advance care plan. The primary hypothesis is that the GOPC form is superior to standard ACP alone and will lead to decreased hospitalisation due to clearer documentation of residents' medical treatment plans. The primary outcome will be an analysis of the effect of the GOPC medical treatment orders on emergency department attendances and hospital admissions at 6 months. Secondary outcome measurements will include change in hospitalisation rates at 3 and 12 months, length of stay and external mortality rates among others. Qualitative interviews, 12 months post GOPC implementation, will be used for process evaluation of the GOPC and to evaluate staff perceptions of the form's usefulness for improving communication and medical decision-making at a time of deterioration. DISSEMINATION: The results will be disseminated in peer review journals and research conferences. This robust randomised controlled trial will provide high-quality data about the influence of medical treatment orders that incorporate ACP or preferences adding to the current gap in knowledge and evidence in this area. TRIAL REGISTRATION NUMBER: ACTRN12615000298516, Results. |
format | Online Article Text |
id | pubmed-5353337 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-53533372017-03-17 Implementation of ‘Goals of Patient Care’ medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial Martin, Ruth S Hayes, Barbara J Hutchinson, Anastasia Yates, Paul Lim, Wen Kwang BMJ Open Geriatric Medicine INTRODUCTION: Systematic reviews demonstrate that advance care planning (ACP) has many positive effects for residents of aged care facilities, including decreased hospitalisation. The proposed Residential Aged Care Facility (RACF) ‘Goals of Patient Care’ (GOPC) form incorporates a resident's prior advance care plan into medical treatment orders. Where none exists, it captures residents' preferences. This documentation helps guide healthcare decisions made at times of acute clinical deterioration. METHODS AND ANALYSIS: This is a mixed methods study. An unblinded cluster randomised controlled trial is proposed in three pairs of RACFs. In the intervention arm, GOPC forms will be completed by a doctor incorporating advance care plans or wishes. In the control arm, residents will have usual care which may include an advance care plan. The primary hypothesis is that the GOPC form is superior to standard ACP alone and will lead to decreased hospitalisation due to clearer documentation of residents' medical treatment plans. The primary outcome will be an analysis of the effect of the GOPC medical treatment orders on emergency department attendances and hospital admissions at 6 months. Secondary outcome measurements will include change in hospitalisation rates at 3 and 12 months, length of stay and external mortality rates among others. Qualitative interviews, 12 months post GOPC implementation, will be used for process evaluation of the GOPC and to evaluate staff perceptions of the form's usefulness for improving communication and medical decision-making at a time of deterioration. DISSEMINATION: The results will be disseminated in peer review journals and research conferences. This robust randomised controlled trial will provide high-quality data about the influence of medical treatment orders that incorporate ACP or preferences adding to the current gap in knowledge and evidence in this area. TRIAL REGISTRATION NUMBER: ACTRN12615000298516, Results. BMJ Publishing Group 2017-03-10 /pmc/articles/PMC5353337/ /pubmed/28283490 http://dx.doi.org/10.1136/bmjopen-2016-013909 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Geriatric Medicine Martin, Ruth S Hayes, Barbara J Hutchinson, Anastasia Yates, Paul Lim, Wen Kwang Implementation of ‘Goals of Patient Care’ medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial |
title | Implementation of ‘Goals of Patient Care’ medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial |
title_full | Implementation of ‘Goals of Patient Care’ medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial |
title_fullStr | Implementation of ‘Goals of Patient Care’ medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial |
title_full_unstemmed | Implementation of ‘Goals of Patient Care’ medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial |
title_short | Implementation of ‘Goals of Patient Care’ medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial |
title_sort | implementation of ‘goals of patient care’ medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial |
topic | Geriatric Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353337/ https://www.ncbi.nlm.nih.gov/pubmed/28283490 http://dx.doi.org/10.1136/bmjopen-2016-013909 |
work_keys_str_mv | AT martinruths implementationofgoalsofpatientcaremedicaltreatmentordersinresidentialagedcarefacilitiesprotocolforarandomisedcontrolledtrial AT hayesbarbaraj implementationofgoalsofpatientcaremedicaltreatmentordersinresidentialagedcarefacilitiesprotocolforarandomisedcontrolledtrial AT hutchinsonanastasia implementationofgoalsofpatientcaremedicaltreatmentordersinresidentialagedcarefacilitiesprotocolforarandomisedcontrolledtrial AT yatespaul implementationofgoalsofpatientcaremedicaltreatmentordersinresidentialagedcarefacilitiesprotocolforarandomisedcontrolledtrial AT limwenkwang implementationofgoalsofpatientcaremedicaltreatmentordersinresidentialagedcarefacilitiesprotocolforarandomisedcontrolledtrial |