Trial Outcomes & Findings for Pragmatic Trial of Video Education in Nursing Homes (NCT NCT02612688)

NCT ID: NCT02612688

Last Updated: 2020-10-12

Results Overview

Number of hospital transfers (number of transfers/person-days alive) over a 12-month observation period among Medicare fee-for-service long-stay residents (in a NH \>=90 days) who are \>=65 years old and who have EITHER advanced dementia or advanced congestive heart failure/chronic obstructive lung disease

• Recruitment status: COMPLETED
• Study phase: NA
• Target enrollment: 197692 participants
• Primary outcome timeframe: 12-month observation period
• Results posted on: 2020-10-12

Participant Flow

Participant milestones

Measure	ACP Video Program Facility asked to implement ACP Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual ACP Procedures Facility follows usual ACP procedures
Overall Study STARTED	33035	70013
Overall Study COMPLETED	33035	70013
Overall Study NOT COMPLETED	0	0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Pragmatic Trial of Video Education in Nursing Homes

Baseline characteristics by cohort

Measure	Advance Care Planning (ACP) Video Program n=33035 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=70013 Participants Facility follows usual Advance Care Planning (ACP) procedures	Total n=103048 Participants Total of all reporting groups
Age, Continuous	80.8 years STANDARD_DEVIATION 8.9 • n=5 Participants	80.9 years STANDARD_DEVIATION 8.8 • n=7 Participants	80.9 years STANDARD_DEVIATION 8.9 • n=5 Participants
Sex: Female, Male Female	19818 Participants n=5 Participants	42170 Participants n=7 Participants	61988 Participants n=5 Participants
Sex: Female, Male Male	13217 Participants n=5 Participants	27843 Participants n=7 Participants	41060 Participants n=5 Participants
Race/Ethnicity, Customized Race/Ethnicity · White	26888 Participants n=5 Participants	58872 Participants n=7 Participants	85760 Participants n=5 Participants
Race/Ethnicity, Customized Race/Ethnicity · Black	4904 Participants n=5 Participants	8575 Participants n=7 Participants	13479 Participants n=5 Participants
Race/Ethnicity, Customized Race/Ethnicity · Asian	240 Participants n=5 Participants	617 Participants n=7 Participants	857 Participants n=5 Participants
Race/Ethnicity, Customized Race/Ethnicity · Hispanic	287 Participants n=5 Participants	626 Participants n=7 Participants	913 Participants n=5 Participants
Race/Ethnicity, Customized Race/Ethnicity · North American Native	331 Participants n=5 Participants	407 Participants n=7 Participants	738 Participants n=5 Participants
Race/Ethnicity, Customized Race/Ethnicity · Other	215 Participants n=5 Participants	491 Participants n=7 Participants	706 Participants n=5 Participants
Race/Ethnicity, Customized Race/Ethnicity · Unknown	170 Participants n=5 Participants	425 Participants n=7 Participants	595 Participants n=5 Participants

PRIMARY outcome

Timeframe: 12-month observation period

Number of hospital transfers (number of transfers/person-days alive) over a 12-month observation period among Medicare fee-for-service long-stay residents (in a NH >=90 days) who are >=65 years old and who have EITHER advanced dementia or advanced congestive heart failure/chronic obstructive lung disease

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=4171 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=8308 Participants Facility follows usual Advance Care Planning (ACP) procedures
Hospital Transfer Rate in Target Cohort	2.4 person-years Standard Deviation 11.8	2.8 person-years Standard Deviation 13.7

SECONDARY outcome

Timeframe: 12-month observation period

Number of hospital transfers (number of transfers/person-days alive) over a 12-month observation period among Medicare fee-for-service long-stay residents (in a NH >=90 days) who are >=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=5766 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=11782 Participants Facility follows usual Advance Care Planning (ACP) procedures
Hospital Transfer Rate Among Long-stay Residents Without Advanced Illness	1.65 person-years Standard Deviation 3.9	1.68 person-years Standard Deviation 4.8

SECONDARY outcome

Timeframe: 100-day observation period

Number of hospital transfers (number of transfers/person-days alive) over a 100-day observation period among Medicare fee-for-service short-stay residents (in a NH <90 days) who are >=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=2538 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=5290 Participants Facility follows usual Advance Care Planning (ACP) procedures
Hospital Transfer Rate Among Short-stay Residents With Advanced Illness	6.9 person-years Standard Deviation 17.8	6.8 person-years Standard Deviation 16.8

SECONDARY outcome

Timeframe: 100-day observation period

Number of hospital transfers (number of transfers/person-days alive) over a 100-day observation period among Medicare fee-for-service short-stay residents (in a NH <90 days) who are >=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=23304 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=50195 Participants Facility follows usual Advance Care Planning (ACP) procedures
Hospital Transfer Rate Among Short-stay Residents Without Advanced Illness	4.5 person-years Standard Deviation 10.3	4.4 person-years Standard Deviation 10.4

SECONDARY outcome

Timeframe: 12-month observation period

Proportion of long-stay residents (in a NH >=90 days) who are >=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease whose last observed advance directive status during their 12-month observation period was: Full Code, Do Not Resuscitate (NOT Do Not Hospitalize), or Do Not Hospitalize. A resident whose last observed status was both Do Not Resuscitate and Do Not Hospitalize is categorized as Do Not Hospitalize only. Analyses will be limited to Genesis HealthCare facilities in which >75% of residents have any advance directive because the remaining Genesis HealthCare and PruittHealth facilities do not have reliable sources for these data.

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=1970 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=2880 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Target Cohort With Last Observed Advance Directive Status Full Code	295 Participants	570 Participants
Proportion of Target Cohort With Last Observed Advance Directive Status Do Not Resuscitate	1288 Participants	2010 Participants
Proportion of Target Cohort With Last Observed Advance Directive Status Do Not Hospitalize	387 Participants	300 Participants

SECONDARY outcome

Timeframe: 12-month observation period

Proportion of long-stay residents (in a NH >=90 days) who are >=65 years old and who do have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease whose last observed advance directive status during their 12-month observation period was: Full Code, Do Not Resuscitate (NOT Do Not Hospitalize), or Do Not Hospitalize. A resident whose last observed status was both Do Not Resuscitate and Do Not Hospitalize is categorized as Do Not Hospitalize only. Analyses will be limited to Genesis HealthCare facilities in which >75% of residents have any advance directive because the remaining Genesis HealthCare and PruittHealth facilities do not have reliable sources for these data.

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=3233 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=5659 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Long-stay Residents Without Advanced Illness With Last Observed Advance Directive Status Full Code	1150 Participants	2210 Participants
Proportion of Long-stay Residents Without Advanced Illness With Last Observed Advance Directive Status Do Not Resuscitate	1714 Participants	3018 Participants
Proportion of Long-stay Residents Without Advanced Illness With Last Observed Advance Directive Status Do Not Hospitalize	369 Participants	431 Participants

SECONDARY outcome

Timeframe: 100-day observation period

Proportion of short-stay residents (in a NH <90 days) who are >=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease whose last observed advance directive status during their 100-day observation period was: Full Code, Do Not Resuscitate (NOT Do Not Hospitalize), or Do Not Hospitalize. A resident whose last observed status was both Do Not Resuscitate and Do Not Hospitalize is categorized as Do Not Hospitalize only. Analyses will be limited to Genesis HealthCare facilities in which >75% of residents have any advance directive because the remaining Genesis HealthCare and PruittHealth facilities do not have reliable sources for these data.

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=1166 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=1701 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Short-stay Residents With Advanced Illness With Last Observed Advance Directive Status Full Code	482 Participants	761 Participants
Proportion of Short-stay Residents With Advanced Illness With Last Observed Advance Directive Status Do Not Resuscitate	581 Participants	858 Participants
Proportion of Short-stay Residents With Advanced Illness With Last Observed Advance Directive Status Do Not Hospitalize	103 Participants	82 Participants

SECONDARY outcome

Timeframe: 100-day observation period

Proportion of short-stay residents (in a NH <90 days) who are >=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease whose last observed advance directive status during their 100-day observation period was: Full Code, Do Not Resuscitate (NOT Do Not Hospitalize), or Do Not Hospitalize. A resident whose last observed status was both Do Not Resuscitate and Do Not Hospitalize is categorized as Do Not Hospitalize only. Analyses will be limited to Genesis HealthCare facilities in which >75% of residents have any advance directive because the remaining Genesis HealthCare and PruittHealth facilities do not have reliable sources for these data.

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=13292 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=19784 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Short-stay Residents Without Advanced Illness With Last Observed Advance Directive Status Full Code	8289 Participants	12899 Participants
Proportion of Short-stay Residents Without Advanced Illness With Last Observed Advance Directive Status Do Not Resuscitate	4541 Participants	6392 Participants
Proportion of Short-stay Residents Without Advanced Illness With Last Observed Advance Directive Status Do Not Hospitalize	462 Participants	493 Participants

SECONDARY outcome

Timeframe: 12-month observation period

Proportion of long-stay residents (in a NH >=90 days) who are >=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease who receive any burdensome treatment (new feeding tube insertions, parenteral therapy, intubation, ICU care) during a 12-month observation period

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=4171 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=8308 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Target Cohort Receiving Any Burdensome Treatment	453 Participants	971 Participants

SECONDARY outcome

Timeframe: 12-month observation period

Proportion of long-stay residents (in a NH >=90 days) who are >=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease who receive any burdensome treatment (new feeding tube insertions, parenteral therapy, intubation, ICU care) during a 12-month observation period

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=5766 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=11782 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Long-stay Residents Without Advanced Illness Receiving Any Burdensome Treatment	465 Participants	1028 Participants

SECONDARY outcome

Timeframe: 100-day observation period

Proportion of short-stay residents (in a NH <90 days) who are >=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease who receive any burdensome treatment (new feeding tube insertions, parenteral therapy, intubation, ICU care) during a 100-day observation period among

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=2538 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=5290 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Short-stay Residents With Advanced Illness Receiving Any Burdensome Treatment	294 Participants	621 Participants

SECONDARY outcome

Timeframe: 100-day observation period

Proportion of short-stay residents (in a NH <90 days) who are >=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease who receive any burdensome treatment (new feeding tube insertions, parenteral therapy, intubation, ICU care) during a 100-day observation period

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=23304 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=50195 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Short-stay Residents Without Advanced Illness Receiving Any Burdensome Treatment	1726 Participants	3405 Participants

SECONDARY outcome

Timeframe: 12-month observation period

Proportion of long-stay residents (in a NH >=90 days) who are >=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease with any hospice enrollment during a 12-month observation period

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=4171 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=8308 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Target Cohort With Any Hospice Enrollment	904 Participants	1878 Participants

SECONDARY outcome

Timeframe: 12-month observation period

Proportion of long-stay residents (in a NH >=90 days) who are >=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease with any hospice enrollment during a 12-month observation period

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=5766 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=11782 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Long-stay Residents Without Advanced Illness With Any Hospice Enrollment	373 Participants	832 Participants

SECONDARY outcome

Timeframe: 100-day observation period

Proportion of short-stay residents (in a NH <90 days) who are >=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease with any hospice enrollment during a 100-day observation period

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=2538 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=5290 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Short-stay Residents With Advanced Illness With Any Hospice Enrollment	588 Participants	1220 Participants

SECONDARY outcome

Timeframe: 100-day observation period

Proportion of short-stay residents (in a NH <90 days) who are >=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease with any hospice enrollment during a 100-day observation period

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=23304 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=50195 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Short-stay Residents Without Advanced Illness With Any Hospice Enrollment	2273 Participants	4875 Participants

SECONDARY outcome

Timeframe: 12-month observation period

Proportion of long-stay residents (in a NH >=90 days) who are >=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease who have any Medicare ACP billing code during their 12-month observation period

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=4171 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=8308 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Target Cohort That Has Medicare ACP Billing Codes	356 Participants	685 Participants

SECONDARY outcome

Timeframe: 12-month observation period

Proportion of long-stay residents (in a NH >=90 days) who are >=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease who have any Medicare ACP billing code during their 12-month observation period

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=5766 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=11782 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Long-stay Residents Without Advanced Illness That Has Medicare ACP Billing Codes	571 Participants	1157 Participants

SECONDARY outcome

Timeframe: 100-day observation period

Proportion of short-stay residents (in a NH <90 days) who are >=65 years old and who have EITHER advanced dementia OR advanced congestive heart failure/chronic obstructive lung disease who have any Medicare ACP billing code during their 100-day observation period

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=2538 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=5290 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Short-stay Residents With Advanced Illness That Has Medicare ACP Billing Codes	224 Participants	479 Participants

SECONDARY outcome

Timeframe: 100-day observation period

Proportion of short-stay residents (in a NH <90 days) who are >=65 years old and who have NEITHER advanced dementia NOR advanced congestive heart failure/chronic obstructive lung disease who have any Medicare ACP billing code during their 100-day observation period

Outcome measures

Measure	Advance Care Planning (ACP) Video Program n=23304 Participants Facility asked to implement Advance Care Planning (ACP) Video Program ACP Video Program: The ACP Video Program consists of five videos that address ACP decisions: (1) General Goals of Care, (2) Goals of Care for Advanced Dementia, (3) Hospice, (4) Hospitalization, and (5) ACP for Healthy Patients. NH staff will offer videos to patients at these clinical triggers: (1) Within 7 days of admission or readmission; (2) Every 6 months for long-stay patients; (3) When there is a significant change in clinical status; (4) When a treatment decision arises for which there is a specific video; and (5) Special circumstances when goals of care are being considered (e.g., family visiting).	Usual Advance Care Planning (ACP) Procedures n=50195 Participants Facility follows usual Advance Care Planning (ACP) procedures
Proportion of Short-stay Residents Without Advanced Illness That Has Medicare ACP Billing Codes	1669 Participants	4068 Participants

Adverse Events

ACP Video Program

Serious events: 0 serious events

Other events: 0 other events

Deaths: 8403 deaths

Usual ACP Procedures

Serious events: 0 serious events

Other events: 0 other events

Deaths: 17251 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Jessica A. Ogarek, Senior Biostatistician

Brown University

Phone: 401-863-9356

Email: jessica_ogarek@brown.edu

Results disclosure agreements

• Principal investigator is a sponsor employee
• Publication restrictions are in place