抄録
Objective: Advance care planning (ACP) is vital for long-term care. However, its operational effects remain unclear. We implemented “ACPSET”, integrating ACP with super-enhanced transitional care (SET). Given the limited evidence on integrated care models, we hypothesized that ACPSET would improve the predictability of facility deaths, enable efficient bed use, and reduce monthly average number of vacant beds. This study evaluated ACP’s impact on facility deaths and ACPSET-related bed availability.
Materials and Methods: In this retrospective cohort study, we compared facility deaths between residents with (n=46) and without (n=842) ACP using propensity score matching (PSM; n=45/group). Welch’s t-test and interrupted time-series analysis (ITSA) were used to compare the natural logarithm of monthly average number of vacant beds between the SET preparation period (October 1, 2021 to March 31, 2023) and the ACPSET implementation period (April 1, 2023 to September 30, 2024). Multiple regression analysis was used to examine the factors associated with vacant beds, including hospital admissions and facility deaths.
Results: PSM-adjusted analysis showed a significantly higher facility death rate in the ACP group (P<0.001), although this did not imply causality. The natural logarithm of vacant beds decreased significantly during the ACPSET implementation (P=0.026). The ITSA showed a significant decreasing trend in vacant beds during the pre-intervention period (P=0.020), with no significant level or trend changes after ACPSET initiation, suggesting no additional ACPSET effect beyond the pre-existing trend. The regression analysis showed that monthly hospital admissions (P=0.0064) and facility deaths (P=0.0498) significantly predicted an increase in vacant beds.
Conclusion: The ACPSET may support facility sustainability without adversely affecting bed availability. ACP may also be associated with an increased number of facility deaths; however, this should be interpreted as a surrogate outcome because the preferred place of death was not assessed.
