Impact of a prospective feedback loop on care review activities in older patients at the end of life. A stepped-wedge randomised trial

被引：4

作者：

Brown, Christine ^{[1
,2
]}

Lee, Xing J. ^{[1
,2
]}

Farrington, Alison ^{[1
,2
]}

Shield, Carla ^{[1
,2
]}

Carter, Hannah E. ^{[1
,2
]}

McPhail, Steven M. ^{[1
,2
,3
]}

Cardona, Magnolia ^{[4
,5
]}

Hillman, Kenneth ^{[6
,7
,8
]}

Callaway, Leonie ^{[9
,10
,11
]}

Willmott, Lindy ^{[12
]}

White, Ben P. ^{[12
]}

Harvey, Gillian ^{[1
,2
,13
]}

Graves, Nicholas ^{[1
,2
,14
]}

Barnett, Adrian G. ^{[1
,2
]}

机构：

[1] Queensland Univ Technol, Australian Ctr Hlth Serv Innovat, Kelvin Grove, Qld, Australia

[2] Queensland Univ Technol, Ctr Hlthcare Transformat, Sch Publ Hlth & Social Work, Kelvin Grove, Qld, Australia

[3] Metro South Hlth, Digital Hlth & Informat Directorate, Brisbane, Qld, Australia

[4] Bond Univ, Inst Evidence Based Healthcare, Robina, Qld, Australia

[5] Gold Coast Univ Hosp, Evidence Based Practice Professorial Unit, Southport, Qld, Australia

[6] Univ New South Wales, Simpson Ctr Hlth Serv Res, South West Sydney Clin Sch, Liverpool, NSW, Australia

[7] Univ New South Wales, Sch Clin Med, Liverpool, NSW, Australia

[8] Ingham Inst Appl Medial Res, Liverpool, NSW, Australia

[9] Royal Brisbane & Womens Hosp, Herston, Qld, Australia

[10] Queensland Univ Technol, Fac Hlth, Kelvin Grove, Qld, Australia

[11] Univ Queensland, Fac Med, Herston, Qld, Australia

[12] Queensland Univ Technol, Fac Business & Law, Australian Ctr Hlth Law Res, Sch Law, Brisbane, Qld, Australia

[13] Flinders Univ S Australia, Coll Nursing & Hlth Sci, Bedford Pk, SA, Australia

[14] Natl Univ Singapore, Duke NUS Postgrad Med Sch, Singapore, Singapore

来源：

BMC GERIATRICS | 2022年 / 22卷 / 01期

基金：

英国医学研究理事会;

关键词：

Non-beneficial treatment; Prospective feedback loop intervention; Stepped-wedge trial; Advance care planning; Older people; End of life; IMPROVE; TOOL;

D O I：

10.1186/s12877-022-03554-x

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Background Hospitalisation rates for older people are increasing, with end-of-life care becoming a more medicalised experience. Innovative approaches are warranted to support early identification of the end-of-life phase, communicate prognosis, provide care consistent with people's preferences, and improve the use of healthcare resources. The Intervention for Appropriate Care and Treatment (InterACT) trial aimed to increase appropriate care and treatment decisions for older people at the end of life, through implementation of a prospective feedback loop. This paper reports on the care review outcomes. Methods A stepped-wedge randomised controlled trial was conducted in three large acute hospitals in Queensland, Australia between May 2020 and June 2021. The trial identified older people nearing the end of life using two validated tools for detecting deterioration and short-term death. Admitting clinical teams were provided with details of patients identified as at-risk with the goal of increasing awareness that end of life was approaching to facilitate appropriate patient centred care and avoid non-beneficial treatment. We examined the time between when the patient was identified as 'at-risk' and three outcomes: clinician-led care review discussions, review of care directive measures and palliative care referrals. These were considered useful indicators of appropriate care at the end of life. Results In two hospitals there was a reduction in the review of care directive measures during the intervention compared with usual care at 21 days (reduced probability of - 0.08; 95% CI: - 0.12 to - 0.04 and - 0.14; 95% CI: - 0.21 to - 0.06). In one hospital there was a large reduction in clinician-led care review discussions at 21 days during the intervention (reduced probability of - 0.20; 95% CI: - 0.28 to - 0.13). There was little change in palliative care referrals in any hospital, with average probability differences at 21 days of - 0.01, 0.02 and 0.04. Discussion The results are disappointing as an intervention designed to improve care of hospitalised older people appeared to have the opposite effect on care review outcomes. The reasons for this may be a combination of the intervention design and health system challenges due to the pandemic that highlight the complexity of providing more appropriate care at the end of life.

引用

页数：9

共 31 条

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