Trial results for the APPROACHES ACP Specialist Program, an intervention for Alzheimer's Disease and related dementias, were posted on ClinicalTrials.gov on 2025-08-26. The program, designed to improve advance care planning, did not demonstrate a statistically significant impact on hospital transfers, hospice enrollment, or in-hospital deaths among 47,396 participants.
Background
Nursing home patients with Alzheimer's disease and related dementias frequently receive unwanted or burdensome treatments, including hospitalizations, which may not align with their preferences. Advance care planning (ACP) is recognized as a crucial strategy to empower patients and their family-caregivers in making informed decisions. It aims to ensure that treatment preferences are proactively documented and honored. The ACP Specialist Program was developed with the goal of improving care and reducing these unwanted, burdensome hospitalizations by enhancing ACP procedures, providing standardized staff education on ACP, and facilitating systematic ACP by existing nursing home staff.
Trial design
This completed study, which did not specify a phase (NA), enrolled a large cohort of 47,396 participants. The trial focused on individuals with Alzheimer Disease and Dementia. The intervention involved the APPROACHES ACP Specialist Program, which aimed to improve advance care planning through enhanced procedures, staff education, and systematic facilitation. A control group was also included for comparison. The measured outcomes included hospital transfers, hospice enrollment, and death in hospital.
Key results
The study reported on several key measurements and analyses:
- Hospital Transfers:
- Participants in the APPROACHES ACP Specialist Program group had a mean of 1.2 hospital transfers (Standard Deviation 2.3).
- The Control group had a mean of 1.3 hospital transfers (Standard Deviation 2.4).
A Poisson Regression analysis for hospital transfers yielded an Incidence Rate Ratio (IRR) of 0.94, with a 95.0% confidence interval of 0.84 to 1.06, and a p-value of 0.3313.
- Hospice Enrollment:
- 1095 participants in the APPROACHES ACP Specialist Program group enrolled in hospice.
- 1181 participants in the Control group enrolled in hospice.
A Logistic Regression analysis for hospice enrollment showed an Odds Ratio (OR) of 0.92, with a 95.0% confidence interval of 0.78 to 1.09, and a p-value of 0.3327.
- Death in Hospital:
- 163 participants in the APPROACHES ACP Specialist Program group died in hospital.
- 146 participants in the Control group died in hospital.
A Logistic Regression analysis for death in hospital resulted in an Odds Ratio (OR) of 1.13, with a 95.0% confidence interval of 0.85 to 1.49, and a p-value of 0.3946.
What this means
Despite the large scale of the APPROACHES ACP Specialist Program and its focus on improving advance care planning for nursing home patients with Alzheimer's disease and related dementias, the trial results indicate no statistically significant impact on the measured outcomes. The program did not significantly reduce hospital transfers, nor did it significantly increase hospice enrollment or alter the rate of in-hospital deaths. These findings suggest that the specific implementation of the ACP Specialist Program, as evaluated in this study, did not achieve its intended objectives of improving care and reducing unwanted hospitalizations through these particular metrics.
Source
The information regarding these trial results was sourced from ClinicalTrials.gov, a public registry of clinical studies. The results for the study NCT03323502, titled "Aligning Patient Preferences: a Role Offering Alzheimer's Patients, Caregivers, and Healthcare Providers Education and Support", were posted on 2025-08-26 on clinicaltrials.gov.