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    <title language="eng">Care consistency with care preferences in nursing homes: A cluster-randomized study of the effects of an advance care planning program (BEVOR).</title>
    <title language="deu">Präferenzkonsistente Behandlung in Pflegeeinrichtungen: Clusterrandomisierte Studie zu den Effekten eines Advance-Care-Planning-Programms (BEVOR)</title>
    <abstract language="deu">Hintergrund: Diese Studie (NCT04333303) untersuchte, ob eine komplexe Advance-Care-Planning(ACP)-Intervention die präferenzkonsistente Behandlung bei Bewohnerinnen und Bewohnern von Pflegeeinrichtungen verbessert.&#13;
&#13;
Methode: 44 deutsche Pflegeeinrichtungen wurden zufällig einer auf individueller, institutioneller und regionaler Ebene konzipierten ACP-Intervention versus Kontrolle zugeordnet. Die Hospitalisierungsrate (primärer Endpunkt) wurde als Surrogat für präferenzkonsistente Behandlungen auf Einrichtungsebene für den 12-monatigen Beobachtungszeitraum analysiert. Sekundäre Endpunkte waren Prozess- und klinische Parameter einschließlich präferenzkonsistenter Behandlung (Analyseebene: Bewohnerinnen und Bewohner/Pflegeeinrichtung). Die Endpunkte wurden mit Poisson- und logistischen Regressionsmodellen mit Incidence Rate Ratios (IRR) und Odds Ratios (OR) als Effektschätzern gemäß Intention-to-treat-Prinzip ausgewertet.&#13;
&#13;
Ergebnisse: Die Intervention erfolgte in 23/44 Pflegeeinrichtungen. Die Hospitalisierungen unterschieden sich nicht signifikant zwischen den Gruppen (IRR 1,0; 95-%-KI: [0,97; 1,1]), sanken jedoch ähnlich stark in beiden Gruppen nach Ausbruch der COVID-19-Pandemie. Die Raten präferenzkonsistenter Behandlungsentscheidungen waren vergleichbar (OR 0,9 [0,4; 1,9]). Die vordefinierte explorative Analyse legt nahe, dass präferenzkonsistente Behandlungen in den 6/23 Pflegeeinrichtungen, die Adhärenzkriterien erfüllten, wahrscheinlicher waren (OR 1,9 [0,7; 5,3]). Schriftliche Notfallpläne überwogen erheblich in der Interventionsgruppe (IRR 11,6 [8,2; 16,4]) und noch stärker in den adhärenten Pflegeeinrichtungen (IRR 30,1 [15,7; 57,6]).&#13;
&#13;
Schlussfolgerung: Die Intervention drang nicht ausreichend durch, insbesondere aufgrund der COVID-19-Pandemie, die ihrerseits mögliche Schwächen der Intervention überlagert haben könnte. Die Frage, ob die Intervention präferenzkonsistente Behandlungen fördern kann oder nicht, kann daher anhand dieser Studie nicht beurteilt werden. Explorative Analysen legen jedoch nahe, dass individuelle ACP-Gespräche in Verbindung mit institutioneller ACP-Organisationsentwicklung die Chancen für präferenzkonsistente Behandlungen erhöhen.</abstract>
    <parentTitle language="deu">Deutsches Ärzteblatt international</parentTitle>
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