RESUMO
PURPOSE: To investigate the impact nurse practitioners' (NPs) documented mortality risk assessments (MRAs) and advance care planning (ACP) discussions have on clinical outcomes for newly enrolled Medicare Advantage nursing home patients. METHODS: Data collection in this mixed-method study consisted of quantitative data from a convenience sample of NPs' MRAs and medical record reviews 6 months later, and qualitative data from two NP focus groups. Quantitative analyses include descriptive statistics, bivariate ANOVA, and logistic regression. The qualitative content analysis included an iterative process of rereading transcribed notes, identifying codes, themes and significant statements. CONCLUSIONS: MRAs prioritize ACP discussions with patients/families (p = .0258). Positive clinical outcomes following ACP discussions include more patients with a comfort goal of care (86% increase), fewer patients with a full-code status (26% reduction), and a reduction in hospitalizations (p = .025). NPs agreed that ACP discussions have a positive impact on patient outcomes including a "good death." IMPLICATIONS FOR PRACTICE: MRAs and ACP discussions are beneficial to achieving better outcomes and fewer hospitalizations. Opportunity exists to further develop policy changes focused on enhancing the NPs' role in MRAs and ACP discussions with nursing home patients and families.