# A Nursing Home Pragmatic Clinical Trial of APPROACHES (Aligning Patient Preferences: a Role Offering Alzheimer's patient, Caregivers, and Healthcare providers Education and Support)

> **NIH NIH R33** · INDIANA UNIVERSITY INDIANAPOLIS · 2021 · $564,020

## Abstract

PROJECT SUMMARY
A significant number of patients Alzheimer's disease or related dementia diagnoses will be cared for in nursing
homes near the end of life. Unfortunately, many of these patients experience unwanted and burdensome
medical treatments, such as potentially avoidable hospitalizations, that negatively impact quality of life.
Advance care planning (ACP) discussions with patients and family caregivers are important to explore goals in
advance of a crisis and support informed, values-based decision-making. The ACP process helps ensure that
preferences about treatments such as hospitalization are known, documented, and honored. Research
indicates that ACP can reduce burdensome treatments and increase the likelihood that care will match
documented preferences. Nursing homes are currently required by regulations to offer ACP to patients and
families. However, there are no training requirements for nursing home staff and approaches to fulfilling this
regulatory and ethical responsibility vary widely, resulting in inconsistent ACP. The “Aligning Patient
Preferences – a Role Offering Alzheimer's patients, Caregivers, and Healthcare providers Education and
Support (APPROACHES)” trial will test the ACP Specialist Program. Existing nursing home staff members will
be trained to enhance care and reduce unwanted, burdensome hospitalizations through improved ACP
procedures, standardized staff education on ACP, and systematic ACP facilitation. The primary trial outcome is
hospital transfers (admissions and emergency department visits) per 1000 person-days alive. Consistent with
the spirit of a pragmatic trial, study outcomes rely on data already collected for quality improvement, clinical or
billing purposes. In the 18 month R21 pilot phase, the aims are to: 1) Establish the trial's organizational
structure and processes; and 2) Pilot test the intervention in 4 nursing homes. In the R33 phase, a pragmatic
cluster randomized clinical trial will be conducted in partnership with 3 nursing home corporations who operate
a combined total of 206 diverse urban and rural facilities in 14 states. The aims of the 42 month R33 phase are
to: 3) Evaluate the primary outcome of hospital transfers over 12 months among patients with dementia in
intervention versus control nursing homes; and 4) Compare ACP documentation, measures of quality of care
at the end of life, and patient and family satisfaction between the intervention versus control nursing homes. If
successful, the ACP Specialist Program will be primed for rapid translation into nursing home practice to
reduce unwanted, burdensome hospitalizations and improve quality of care for patients with dementia.

## Key facts

- **NIH application ID:** 10250086
- **Project number:** 5R33AG057463-05
- **Recipient organization:** INDIANA UNIVERSITY INDIANAPOLIS
- **Principal Investigator:** SUSAN E HICKMAN
- **Activity code:** R33 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $564,020
- **Award type:** 5
- **Project period:** 2017-09-30 → 2025-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10250086

## Citation

> US National Institutes of Health, RePORTER application 10250086, A Nursing Home Pragmatic Clinical Trial of APPROACHES (Aligning Patient Preferences: a Role Offering Alzheimer's patient, Caregivers, and Healthcare providers Education and Support) (5R33AG057463-05). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10250086. Licensed CC0.

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