Association between advance care planning implementation and home deaths in visiting nurse agencies

This secondary analysis of a nationwide survey examined the association between self-assessed advance care planning (ACP) implementation at the visiting nurse agency (VNA) level and home deaths among patients receiving end-of-life care. Of 369 VNAs analyzed, VNAs were classified into two groups: Home Death Predominant VNAs (the number of home deaths was equal to or greater than the number of hospital deaths) and Hospital Death Predominant VNAs (the number of hospital deaths exceeded the number of home deaths). ACP implementation was evaluated using 10 self-assessment items. In multivariable logistic regression analysis, a higher ACP total score was significantly associated with Home Death Predominant VNAs after adjustment for selected agency-level characteristics (aOR, 1.08; 95% CI, 1.03–1.13; p < 0.01). Six of the 10 ACP practices were significantly more frequently reported in Home Death Predominant VNAs: understanding individual’s values and life goals, understanding individual’s wishes regarding medical treatment and care, appropriate explanation by a physician or other healthcare provider, discussion with the individual, family members, and the healthcare team, record-keeping of discussions, and repeatedly discussing changes in individual’s wishes. These findings suggest that higher self-assessed ACP implementation is associated with a greater predominance of home deaths at the agency level.