Results Summary

PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.

Background

Almost 25 percent of nursing home residents go to the hospital for medical treatment within the first month of living in their nursing home. These hospital trips cost Americans $14.3 billion each year. Nursing homes residents who go to the hospital might get sicker while there. Studies suggest that two-thirds of these hospitalizations could be prevented. Many times, nursing home residents go to the hospital because they or their families insist on it.

Project Purpose

The research team wanted to understand what nursing home residents and their families need to know when deciding whether to go to the hospital. Researchers wanted to learn how residents and families want to be involved in this decision and what factors are most important to them. The research team also wanted to determine whether a decision aid affected residents’ and families’ decision-making process about whether to go to the hospital. Decision aids help people choose between two or more healthcare options based on what is most important to them.

Methods

This study had two parts. First, researchers interviewed 96 nursing home residents, 75 family members, and 100 healthcare providers at 19 nursing homes. Researchers asked about residents’ and family members’ experiences with deciding whether to go to the hospital for a medical problem or to stay and get treatment in the nursing home. Researchers used the information from the interviews to create a decision aid called Go to the Hospital or Stay Here?

For the second part of the study, researchers assigned 191 nursing home residents from 15 nursing homes to two groups. In one group, 96 nursing home residents received the decision aid. The other group of 95 residents did not receive the decision aid. Three months later, researchers used a knowledge test to compare the two groups’ knowledge about when to go to the hospital, feeling of preparation for making decisions, and number of transfers to the hospital. Researchers also looked for patterns in residents’ preferences about getting treatment in the nursing home or in the hospital.

Findings

From the interviews, the research team found that, before participating in the study, most nursing home residents had never thought about whether it was better to go to the hospital or stay in the nursing home for treatment. About half of family members and nursing home staff also had never thought about this question before.

Family members wanted more information overall. Nursing home residents wanted more involvement in deciding whether to go to the hospital. Residents were more likely than family members to say their choice to go to hospital would depend on how severe their health condition was.

Residents and families described their nursing home and hospital experiences in detail. They understood the risks and benefits of staying in the nursing home versus going to the hospital. For example, they worried that nursing homes did not have enough staff to care for sick residents, but they liked that the staff know residents personally. They thought staff at the hospital might not understand residents as well as the nursing home staff did.

Most research on decision aids focuses on how patients feel about the decision-making process and how they use information to make decisions. In the first part of the study, researchers found a third consideration: Some residents said they had asked others to make the decision for them. They did so because they did not feel like they could make an important decision on their own or that they were too frail, ill, or tired.

In the second phase of the study, nursing home residents who received the decision aid went to the hospital about as often as residents who did not get the decision aid. Residents who received the decision aid had significantly more knowledge about the decision to go to the hospital than residents who did not receive the decision aid. Almost all the participants who received the decision aid said it was helpful.

Limitations

Many nursing home residents did not complete the second phase of the study, and researchers could not follow their progress to find out whether they took additional trips to the hospital. Results might not be the same with a larger group of residents who all complete the study.

Conclusions

Deciding whether to go to the hospital is a complex process for nursing home residents and their families. Researchers found that most participants had never thought about having to make this decision. Participants found the decision aid helpful, but it did not affect decisions about whether or not residents would go to the hospital.

More to Explore...

Dissemination Activities

Through limited competition, PCORI awarded 25 of the 50 Pilot Projects up to $50,000 to support dissemination and implementation of their activities and findings through the PCORI Pilot Project Learning Network (PPPLN) funding. The deliverables listed below are a result of convenings and conferences supported by this funding, whose efforts align with the PCORI strategic goal of disseminating information and encouraging adoption of PCORI-funded research results.

Period: September 2015 to February 2016
Budget: $49,999

Publications

A Guide for Family Members Demanding Hospitalization on McKnights.com

Florida Atlantic University Offers Life's Little Hospitalization Book on ProviderNation.com 

They Know Me Here: Patients' Perspectives on Their Nursing Home Experience in OJIN

Presentations

"Go to the Hospital or Stay Here? A Decision Guide for Patients and Families"
American College of Health Care Administrators Annual Convocation (on page 24 of conference booklet)

"Reducing Unnecessary Rehospitalization of NH Residents Using INTERACT: Involving Residents and Families in the Decision"
Miami Area Geriatric Education Center

"Go to the Hospital or Stay Here: A Decision Guide for Patients and Families"
AHCA/NCAL Quality Network 2015 Teleconference and 2016 Quality Summit and at the Maimi National Readmission Prevention Collaborative

"Reducing Unnecessary Hospitilizations"
Vermont Health Care Association

"Reducing Avoidable Hospitilizations of NH residents as a Result of Resident and Family Insistence: Results of a PCORI Project"
Gerontological Society of America's 2015 Annual Scientific Meeting in Orlando

Project Information

Ruth M. Tappen, EdD, RN, FAAN
Florida Atlantic University (FAU)
$677,473
Involving Nursing Home Residents and Families in Acute Care Transfer Decisions

Key Dates

June 2012
June 2015
2012
2015

Study Registration Information

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Has Results
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State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 4, 2022