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Implementation of 'Goals of Patient Care' medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial.
BMJ Open. 2017 03 10; 7(3):e013909.BO

Abstract

INTRODUCTION

Systematic reviews demonstrate that advance care planning (ACP) has many positive effects for residents of aged care facilities, including decreased hospitalisation. The proposed Residential Aged Care Facility (RACF) 'Goals of Patient Care' (GOPC) form incorporates a resident's prior advance care plan into medical treatment orders. Where none exists, it captures residents' preferences. This documentation helps guide healthcare decisions made at times of acute clinical deterioration.

METHODS AND ANALYSIS

This is a mixed methods study. An unblinded cluster randomised controlled trial is proposed in three pairs of RACFs. In the intervention arm, GOPC forms will be completed by a doctor incorporating advance care plans or wishes. In the control arm, residents will have usual care which may include an advance care plan. The primary hypothesis is that the GOPC form is superior to standard ACP alone and will lead to decreased hospitalisation due to clearer documentation of residents' medical treatment plans. The primary outcome will be an analysis of the effect of the GOPC medical treatment orders on emergency department attendances and hospital admissions at 6 months. Secondary outcome measurements will include change in hospitalisation rates at 3 and 12 months, length of stay and external mortality rates among others. Qualitative interviews, 12 months post GOPC implementation, will be used for process evaluation of the GOPC and to evaluate staff perceptions of the form's usefulness for improving communication and medical decision-making at a time of deterioration.

DISSEMINATION

The results will be disseminated in peer review journals and research conferences. This robust randomised controlled trial will provide high-quality data about the influence of medical treatment orders that incorporate ACP or preferences adding to the current gap in knowledge and evidence in this area.

TRIAL REGISTRATION NUMBER

ACTRN12615000298516, Results.

Authors+Show Affiliations

Northern Health, Epping, Victoria, Australia. University of Melbourne, Melbourne, Victoria, Australia.Northern Health, Epping, Victoria, Australia.Northern Health, Epping, Victoria, Australia. Deakin University, Geelong, Victoria, Australia.University of Melbourne, Melbourne, Victoria, Australia. Austin Health, Heidelberg, Victoria, Australia.Northern Health, Epping, Victoria, Australia. University of Melbourne, Melbourne, Victoria, Australia. Melbourne Health, Melbourne, Victoria, Australia.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28283490

Citation

Martin, Ruth S., et al. "Implementation of 'Goals of Patient Care' Medical Treatment Orders in Residential Aged Care Facilities: Protocol for a Randomised Controlled Trial." BMJ Open, vol. 7, no. 3, 2017, pp. e013909.
Martin RS, Hayes BJ, Hutchinson A, et al. Implementation of 'Goals of Patient Care' medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial. BMJ Open. 2017;7(3):e013909.
Martin, R. S., Hayes, B. J., Hutchinson, A., Yates, P., & Lim, W. K. (2017). Implementation of 'Goals of Patient Care' medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial. BMJ Open, 7(3), e013909. https://doi.org/10.1136/bmjopen-2016-013909
Martin RS, et al. Implementation of 'Goals of Patient Care' Medical Treatment Orders in Residential Aged Care Facilities: Protocol for a Randomised Controlled Trial. BMJ Open. 2017 03 10;7(3):e013909. PubMed PMID: 28283490.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implementation of 'Goals of Patient Care' medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial. AU - Martin,Ruth S, AU - Hayes,Barbara J, AU - Hutchinson,Anastasia, AU - Yates,Paul, AU - Lim,Wen Kwang, Y1 - 2017/03/10/ PY - 2017/3/12/entrez PY - 2017/3/12/pubmed PY - 2017/12/27/medline KW - Advance Care Planning KW - End-Of-Life KW - Medical Treatment Orders KW - Residential Aged Care Facilities SP - e013909 EP - e013909 JF - BMJ open JO - BMJ Open VL - 7 IS - 3 N2 - INTRODUCTION: Systematic reviews demonstrate that advance care planning (ACP) has many positive effects for residents of aged care facilities, including decreased hospitalisation. The proposed Residential Aged Care Facility (RACF) 'Goals of Patient Care' (GOPC) form incorporates a resident's prior advance care plan into medical treatment orders. Where none exists, it captures residents' preferences. This documentation helps guide healthcare decisions made at times of acute clinical deterioration. METHODS AND ANALYSIS: This is a mixed methods study. An unblinded cluster randomised controlled trial is proposed in three pairs of RACFs. In the intervention arm, GOPC forms will be completed by a doctor incorporating advance care plans or wishes. In the control arm, residents will have usual care which may include an advance care plan. The primary hypothesis is that the GOPC form is superior to standard ACP alone and will lead to decreased hospitalisation due to clearer documentation of residents' medical treatment plans. The primary outcome will be an analysis of the effect of the GOPC medical treatment orders on emergency department attendances and hospital admissions at 6 months. Secondary outcome measurements will include change in hospitalisation rates at 3 and 12 months, length of stay and external mortality rates among others. Qualitative interviews, 12 months post GOPC implementation, will be used for process evaluation of the GOPC and to evaluate staff perceptions of the form's usefulness for improving communication and medical decision-making at a time of deterioration. DISSEMINATION: The results will be disseminated in peer review journals and research conferences. This robust randomised controlled trial will provide high-quality data about the influence of medical treatment orders that incorporate ACP or preferences adding to the current gap in knowledge and evidence in this area. TRIAL REGISTRATION NUMBER: ACTRN12615000298516, Results. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/28283490/Implementation_of_'Goals_of_Patient_Care'_medical_treatment_orders_in_residential_aged_care_facilities:_protocol_for_a_randomised_controlled_trial_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=28283490 DB - PRIME DP - Unbound Medicine ER -