Implementation of Goals of Care Communication Innovation Among Nursing Homes: A Multiple Case Study Design |
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| Institution: | 1. Department of Health management & Informatics, College of Community Innovation and Education, University of Central Florida, Orlando, FL, USA;2. Division of Geriatric Medicine and Palliative Care Program, University of North Carolina, Chapel Hill, NC, USA;3. Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Public Health, University of North Carolina, Chapel Hill, NC, USA;4. School of Nursing, Duke University, Durham, NC, USA;5. Partnerships in Aging Program, University of North Carolina, Chapel Hill, NC, USA;6. Department of Global Health and Health Services, University of Washington, Seattle, WA, USA;1. Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada;2. Faculty of Health, University of Plymouth, Plymouth, United Kingdom;3. Department of Neurosciences, University of California San Diego, La Jolla, CA, USA;4. Department of Medicine, University of Calgary, Calgary, Alberta, Canada;5. Department of Psychiatry and Department of Neuroscience, Western University, London, Ontario, Canada |
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| Abstract: | ObjectiveNursing homes (NHs) provide care to residents with serious illness and related complex health care needs. As such, discussions about end-of-life care between NH staff and residents and families are necessary to ensure residents receive care consistent with their goals. Interventions such as video decision aids have been developed to promote discussions and improve advance care planning, but few studies have examined how NH characteristics may relate to the implementation of these interventions; such information might lead toward more use of successful interventions. The purpose of this study is to understand NH characteristics that are associated with the implementation of the Goals of Care (GOC) intervention, which combined a video decision aid with a structured discussion to guide decision-making in advanced dementia.DesignA multiple case study.Setting and ParticipantsStaff surveys were conducted to examine factors related to implementation effectiveness in 11 NHs in North Carolina that participated in the GOC trial.MethodsQuestions measured the dependent variable of implementation effectiveness: the consistency and quality of use of the GOC intervention. NH organizational characteristics were measured using publicly available data and an administrator survey. The analysis consisted of pattern matching logic.ResultsHigh management support aligned with implementation effectiveness within NHs. In addition, the within case pattern analysis indicated additional characteristics related to implementation effectiveness. Facility size, Medicare beds, residents’ racial composition, and star rating were related to implementation effectiveness across 6 of the 11 NHs. NH financial resources, such as size and number of Medicare beds, may be important factors for successful implementation.Conclusion and ImplicationsNHs seeking to implement advance care planning interventions should focus on within and across NH differences, such as adequate management and financial support prior to implementation to increase the likelihood of implementation effectiveness. |
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| Keywords: | Nursing homes resources implementation goals of care case study |
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