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Organisational and advance care planning program characteristics associated with advance care directive completion: a prospective multicentre cross-sectional audit among health and residential aged care services caring for older Australians

机译:与先进护理指令完成相关的组织和预付护理计划特征:在澳大利亚较旧的卫生和住宅老年护理服务中的预期多环境横截面审计

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Advance care planning (ACP) and advance care directive (ACD) completion improve outcomes for patients, family, clinicians and the healthcare system. However, uptake remains low. Despite increasing literature regarding organisational-level ACP characteristics leading to success, there is a lack of data measuring the impact of these factors on ACD prevalence. A prospective multi-centre, cross-sectional audit of health records among older Australians accessing general practices (GP), hospitals and residential aged care facilities (RACF) was undertaken to describe organisational and ACP-program characteristics across services, document ACD prevalence, and assess organisation-level predictors of ACD prevalence. Organisational-level data included general and ACP-program characteristics. Patient/resident data included demographics and presence of ACDs. One hundred organisations (GP?=?15, hospitals?=?27, RACFs?=?58) participated, contributing data from 4187 patient/resident health records. Median prevalence of ACDs across organisations was 19.4%, (range?=?0–100%). In adjusted models, organisational sector type was the strongest predictor of ACD prevalence, with higher rates in RACFs (unadjusted 28.7%, adjusted 20.6%) than hospitals (unadjusted 6.4%, adjusted 5.8%) or GPs (unadjusted 2.5%, adjusted 6.6%). RACFs in regional and rural/remote areas had higher prevalence than metropolitan organisations. Organisations supported by government funding and those that were Not For Profit had higher prevalence than those that were privately funded, and organisations with an ACP program that had been implemented at least 3 years before data collection had higher prevalence than those with either no program or a more recent program. The median ACD prevalence was low, with substantial variation across organisations. Sector type was the strongest predictor, being highest in RACFs. Low prevalence rates, overall and in particular sectors, have implications for improvements. Further research into organisational factors associated with ACP/ACD completion is required.
机译:提前护理计划(ACP)和先进护理指令(ACD)完成改善患者,家庭,临床医生和医疗保健系统的结果。但是,摄取仍然很低。尽管有关组织级的ACP特性的文献增加,但缺乏数据测量这些因素对ACD流行影响的数据。在访问一般实践(GP),医院和住宅老年护理设施(RACF)的澳大利亚旧澳大利亚人的健康记录的横断面审计,以描述跨服务,文件ACD普遍存在的组织和ACP计划特征评估ACD患病率的组织级预测因子。组织级数据包括一般和ACP程序特征。患者/居民数据包括人口统计数据和ACD的存在。一百个组织(GP?=?15,医院?=?27,RACFS?=?58)参与,从4187名患者/居民健康记录中贡献数据。跨组织的ACD中位数普遍性为19.4%,(范围?= 0-100%)。在调整后的模型中,组织部门类型是ACD患病率最强的预测因子,RACF的率较高(未经调整的28.7%,调整为20.6%)(未经调整的6.4%,调整5.8%)或GPS(未经调整的2.5%,调整为6.6%) )。区域和农村/偏远地区的RACS比大都市组织具有更高的流行。政府资金支持的组织以及不盈利的组织比私人资助的人和私人资助的组织,并且在数据收集之前至少3年实施的ACP计划的组织比没有计划或者的人员普遍存在最近的计划。中位数普遍存在率低,组织跨越大幅度。行业类型是最强的预测因子,在RACF中最高。低流行率,总体和特定部门,对改进有影响。需要进一步研究与ACP / ACD完成相关的组织因素。

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