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Program to increase use of advance directives reduces use of health care services

Implementation of program does not affect satisfaction or mortality

CHICAGO - Implementation of a systematic program in which nursing home residents or their families decide in advance about the type of care the resident wishes to receive in difficult medical circumstances reduces the number of hospitalizations and use of healthcare resources without affecting satisfaction or mortality, according to an article in the March 15 issue of The Journal of the American Medical Association (JAMA).

D. William Molloy, MRCP, FRCPC, from McMaster University, Hamilton, Ontario, and colleagues evaluated use of "advanced directives" -- written indications of a patient's wishes about their medical care in six nursing homes in Ontario, Canada. Three of the nursing homes enacted a systematic advanced directives program using the "Let Me Decide" advanced directive tool. A registered nurse from each of the homes attended a two-day workshop to train as health care facilitators. They learned a specific approach to educating hospital staff, nursing home staff, residents, and families about directives and measuring a person's capacity to complete directives, then put this program into action. The other three nursing homes continued their usual policies for advance directives.

The authors found that nursing homes using the advanced directives program reported fewer hospitalizations per resident and less resource use resulting in an average savings of $1,200 U.S. per patient. The proportion of deaths that occurred in the two groups of nursing homes were similar, as were satisfaction levels with the quality of care received.

"Systematic application of the 'Let Me Decide' advance directives in nursing homes can reduce costs substantially by reducing hospitalizations," the authors write. "Replications of this study, with exploration of generalizability in different settings, would greatly strengthen the case for a widespread program of systematic
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Contact: Veronica Billard
905-525-9140 x22169
Center for the Advancement of Health
13-Mar-2000


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