ArticleJournal of the American Geriatrics Society2021
An advance care planning long-term care initiative in response to COVID-19.
Article in Journal of the American Geriatrics Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.
- How Have Quality Improvement Strategies Been Adopted and How Has Impact Been Assessed in Care Homes for Older People? A Systematic Search and Narrative Review.International journal of older people nursing · 2025Pooled it
- The impact of the COVID-19 pandemic on end-of-life care in LTCFs in England: A qualitative study of LTCF staff experiences.Palliative care and social practice · 2026Article
- Situation, Education, Innovation, and Recommendation: A Large-Scale Systematic Review of Advance Care Planning in the Age of COVID-19.Healthcare (Basel, Switzerland) · 2024Review
- Understanding advance care planning in care homes throughout the COVID-19 pandemic: A critical realist review and synthesis.Palliative medicine · 2023Review
- Advanced care planning in the early phase of COVID-19: a rapid review of the practice and policy lessons learned.Frontiers in health services · 2023Review
- Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update.Journal of the American Medical Directors Association · 2022Article
- Stakeholders' views on priorities essential for establishing a supportive environment for clinical trials in nursing homes.Journal of the American Geriatrics Society · 2022Article
- An advance care planning long-term care initiative in response to COVID-19.Journal of the American Geriatrics Society · 2021Article
- Palliative Approach to Care Education for Multidisciplinary Staff of Long-Term Care Homes: A Pretest Post-Test Study.Gerontology & geriatric medicineArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveDescribe a systematic approach to address advance care planning (ACP) during a COVID-19 outbreak and its impact on the incidence of new do-not-hospitalize (DNH) directives among long-term care (LTC) residents.
designProspective quality improvement initiative.
settingTwo long-term chronic care campuses within a large academic healthcare organization.
participantsLTC residents with activated healthcare proxies who lacked DNH directives based on documentation in the electronic medical record (EMR) as of April 13, 2020.
interventionUsing a structured discussion guide, trained healthcare staff from various disciplines contacted the residents' proxies to conduct COVID-19 focused ACP discussions. Residents without DNH directives with COVID-19 were prioritized. Preferences ascertained in the discussion were communicated to the residents' primary care teams and directives were updated in the EMR accordingly. MEASUREMENTS: Residents who acquired a new DNH directive during the study initiative were determined using the EMR. Subsequent changes in DNH orders, hospitalizations, and deaths were ascertained by retrospective chart review from the date of new DNH through August 5, 2020.
resultsAt baseline, 315/581 (54%) of LTC residents did not have a DNH directive. Their mean age was 87 (±9) years and 70% were female. Following ACP discussions, 124/315 (39%) of residents acquired a new DNH directive. Among residents with new DNH directives, 65/124 (52%) were diagnosed with COVID-19 from April 2, 2020 to May 21, 2020. During follow-up, only 6/124 (4.8%) residents had their DNH order reversed, 2/124 (1.6%) residents were hospitalized with illnesses unrelated to COVID-19, and 29/124 (23%) died.
conclusionsThere was substantial opportunity to increase the proportion of LTC residents with DNH orders during the COVID-19 pandemic through a systematic ACP initiative which utilized real-time EMR data. New directives to avoid hospitalizations were sustained among the majority of residents beyond the peak of the pandemic.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.