Reports From The Field-End-of-life care
Advance directives found to reduce utilization
Advance directives are commonly used in the community, but little is known about the effects of their implementation. Researchers studying the impact of advance directives found that they reduce health services utilization without reducing patient and family satisfaction or increasing mortality, according to a recent study in the Journal of the American Medical Association.
Researchers followed 1,292 residents in six Canadian nursing homes with more than 100 residents each. The "Let Me Decide" advanced directives program educated local hospital and nursing home staffs, residents, and their families about advance directives, offering competent residents (or next of kin for mentally incompetent residents) an advance directive that provided a range of health care choices for life-threatening illness, cardiac arrest, and nutrition issues. The six nursing homes were pair-matched on key characteristics, and one home per pair was randomized to take part in the "Let Me Decide" program.
Positive results
Of 527 participating residents in the intervention nursing homes, 49% of competent residents and 78% of families of incompetent residents completed advance directives. Findings include:
• Intervention nursing homes reported fewer hospitalizations — a mean of 0.27, compared with 0.48 for nonintervention nursing homes.
• Intervention nursing homes reported lower average total cost per patient — $3,490 Canadian vs. $5,239 CanadianCMA for the control homes.
• Intervention nursing homes reported a comparable proportion of deaths -— 24% in intervention homes vs. 28% in nonintervention homes.
[See: Molloy DW, Guyatt GH, Russo R, et al. Systematic implementation of an advance directive program in nursing homes: A randomized controlled trial. JAMA 2000; 283:1,437-1,444.]
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