Evaluating the Association between the Implementation of the PoET (Prevention of Error-Based Transfers) Southwest Spread Project and Palliative Care Provision: A Quasi-Experimental Matched Cohort Study Using Population-Level Health Administrative Data

Henry Yu-Hin Siu; Shuaib Hafid; David Kirkwood; Dawn Elston; Richard Perez; Aaron Jones; Jill Oliver; Paula Chidwick; Theresa Nitti; Andrew Costa

doi:10.1016/j.jamda.2024.01.025

Evaluating the Association between the Implementation of the PoET (Prevention of Error-Based Transfers) Southwest Spread Project and Palliative Care Provision: A Quasi-Experimental Matched Cohort Study Using Population-Level Health Administrative Data

J Am Med Dir Assoc. 2024 Mar 8:104956. doi: 10.1016/j.jamda.2024.01.025. Online ahead of print.

Authors

Affiliations

¹ Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada. Electronic address: siuh3@mcmaster.ca.
² Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
³ ICES McMaster University, Hamilton, Ontario, Canada.
⁴ ICES McMaster University, Hamilton, Ontario, Canada; Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
⁵ William Osler Health System, Brampton, Ontario, Canada.

PMID: 38431263
DOI: 10.1016/j.jamda.2024.01.025

Abstract

Objectives: The PoET (Prevention of Error-based Transfers) project seeks to align long-term care (LTC) home informed consent practices to existing legislation, thereby reducing consent-related error-based transfers to acute care. We sought to measure changes in resident-level palliative care provision after participating in the PoET Southwest Spread Project (PSSP), and to identify patient and LTC home characteristics associated with palliative care provision.

Design: Quasi-experimental matched (1:1 ratio) cohort study design using linked population-based health administrative data.

Setting: Sixty LTC homes (PSSP = 30; Control = 30) in Ontario, Canada, from November 2019 to December 2021.

Methods: We matched 30 PSSP to 30 control homes and described incidence rates for resident-level palliative care provision (ie, physician palliative care encounters and palliative medication prescriptions) during the 7-month postimplementation period. We used generalized linear mixed models to evaluate the association between PSSP implementation and palliative care provision during the postimplementation period. We adjusted for resident-level characteristics (ie, age, sex, comorbidity status) and home-level characteristics (ie, rurality status, profit model, COVID-19 impact). We identified a decedent subcohort to measure palliative care provision patterns during the last 2 months of life.

Results: We captured a matched cohort of 8894 residents (PSSP = 4103; Control = 4791). Incidence rates of palliative care encounters increased during the postimplementation period for PSSP (82.6 to 85.4 per 100 person-months) but not for control residents (68.8 to 65.3 per 100 person-months). After adjusting for key covariates, PSSP exposure was associated increased palliative care provision (incidence rate ratio 2.47, 95% CI 2.31-2.64) and palliative care medication prescription (1.16, 95% CI 1.12-1.20). Larger home size, certain health regions, and higher number of comorbidities were associated with increased physician palliative care encounters.

Conclusions and implications: By promoting correct informed consent practices in LTC, PSSP participation increased palliative care provision for PSSP LTC residents across all settings.

Keywords: informed consent; long-term care; nursing homes; palliative care.