Implementing PROVEN (Pragmatic Trial of Video Education in Nursing Homes)
Vincent Mor, PhD, Professor of Medical Science, Florence Pirce Grant University Professor, Health Services, Policy, and Practice, at Brown University School of Public Health
Pragmatic clinical trial; Video education; Nursing homes; Advance care planning; Electronic medical record; Healthcare systems; Local champions; Patient engagement; Patient preferences
PROVEN, an NIH Health Care Systems Research Collaboratory demonstration project, is a pragmatic, cluster-randomized controlled trial of an advance care planning video intervention conducted in two large nursing home systems.
Nursing homes are complex healthcare systems, with 3 million patients admitted annually, many with advanced comorbid conditions. Advance care planning is a process of communication that aligns care with patient preferences and is associated with better outcomes.
The goal of PROVEN is to evaluate the effectiveness of showing advance care planning videos to new and long-stay nursing home patients and their families. The videos are designed to aid further clinical conversations with patients. The 6-8 minute videos address such topics as:
- General goals of care
- Goals of care for advanced dementia
- Advance care planning for healthy patients
The PROVEN study encountered unanticipated complications in the mechanics of introducing videos into daily nursing home operations. Practical matters such as the time of day, staff availability, number of admissions, and video delivery platform added complexity to the intervention.
Is there a way to allow nursing home residents to view the videos at their convenience with family members present?
The study initially had challenges around healthcare systems’ compliance reporting and different rates of offering the videos versus patients actually viewing the videos. Also difficult was accommodating turnover in key partner staff including implementation liaisons and advance care planning champions, who are key to the success of the program.
Nursing homes currently are undergoing a multiplicity of quality improvement initiatives and responses to regulations. Integrating the video intervention will be an ongoing challenge.
For More Information
Read more about the PROVEN demonstration project on its website at the NIH Collaboratory.
@PCTGrandRounds, @Collaboratory1, @PCORnetwork