The association of nurse practitioners' mortality risk assessments and advance care planning discussions on nursing home patients' clinical outcomes.
OBJECTIVE
To investigate the impact nurse practitioners' (NPs) documented mortality risk assessments (MRAs) and advance care planning (ACP) discussions have on clinical outcomes for newly enrolled Medicare Advantage nursing home patients.


METHODS
Data collection in this mixed-method study consisted of quantitative data from a convenience sample of NPs' MRAs and medical record reviews 6 months later, and qualitative data from two NP focus groups. Quantitative analyses include descriptive statistics, bivariate ANOVA, and logistic regression. The qualitative content analysis included an iterative process of rereading transcribed notes, identifying codes, themes and significant statements.


CONCLUSIONS
MRAs prioritize ACP discussions with patients/families (p = .0258). Positive clinical outcomes following ACP discussions include more patients with a comfort goal of care (86% increase), fewer patients with a full-code status (26% reduction), and a reduction in hospitalizations (p = .025). NPs agreed that ACP discussions have a positive impact on patient outcomes including a "good death."


CONCLUSIONS
MRAs and ACP discussions are beneficial to achieving better outcomes and fewer hospitalizations. Opportunity exists to further develop policy changes focused on enhancing the NPs' role in MRAs and ACP discussions with nursing home patients and families.
School of Nursing, College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts.|Optum Health, Eden Prairie, Minnesota.
Susan E
SE
Mullaney
School of Nursing, College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts.|Center for Gerontology Research and Partnerships, College of Health Services, University of Massachusetts Lowell, Lowell, Massachusetts.|Regional Consortium for Community-Engaged Gerontology Researchers, College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts.
Karen
K
Devereaux Melillo
Department of Community Health & Sustainability, University of Massachusetts Lowell, Lowell, Massachusetts.
A James
AJ
Lee
Optum Health, Eden Prairie, Minnesota.
Robert
R
MacArthur
D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009722:Nurse Practitioners / Q000458:organization & administration*; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care / Q000379:methods*; D018570:Risk Assessment; D011795:Surveys and Questionnaires
End of life; advanced care planning; decision making; long-term care; nurse practitioners; palliative care