Evaluation of a Novel Decision Guide “Go to the Hospital or Stay Here?” for Nursing Home Residents and Families: A Randomized Trial

Initiatives to reduce potentially preventable hospitalizations of nursing home residents have focused on staff response to changes in condition and advance care planning. Yet, resident and family insistence on transfer has been one of the most intractable sources of these hospitalizations, although not the target of active intervention until now. Consented residents and family members in the intervention group received a newly developed decision aid entitled, “Go to the Hospital or Stay Here?,” providing information on the risks and benefits of transfer versus remaining in the nursing home. This person-centered decision aid was developed from the results of 271 interviews of residents, families, and providers to identify what they wanted to know and any misunderstandings surrounding the transfer process. Engaging residents in the decision respects their right to participate and provides the information they need to make a deliberative decision. The intervention group showed a gain in knowledge and reduction in decisional conflict but reported decreased decisional preparation. There was no decrease in transfers compared to the control group. Evaluation of the decision guide by residents and families was positive. Targets: Nursing home residents and their family members. Intervention: To provide information regarding the decision to stay in the nursing home or transfer to acute care due to a change in condition. Mechanisms of Action: Decision aid “Go the “Hospital or Stay Here?” to impart knowledge regarding the decision to remain in the nursing home or transfer to acute care. Outcomes: Use of the Guide was found to increase residents’ and family members’ knowledge and decrease decisional conflict, but it did not increase decisional preparation. No reduction in transfers was found. Residents and families rated the Guide as very helpful.