Primary Palliative Care for Emergency Medicine (PRIM-ER)

Conditions

Emergencies

Keywords

Emergency Department, Palliative Care

Brief summary

This proposal builds upon the evaluation of Primary Palliative Care Education, Training, and Technical Support for Emergency Medicine (PRIM-ER) implemented in a cluster-randomized, stepped wedge design in 33 Emergency Departments (EDs).

Katharine Lawrence, Rebecca Liddicoat Yamarik, Allison M. Cuthel, Cheryl Herchek, Nina Siman et al. (6 authors)

BMC Palliative Care2026-08-20

10.1186/s12904-026-02280-0

Palliative Care Initiated in the Emergency Department: A Cluster Randomized Clinical Trial.

Grudzen CR, Siman N, Cuthel AM, Adeyemi O, Yamarik RL, Goldfeld KS, PRIM-ER Investigators, Abella BS, Bellolio F, Bourenane S, Brody AA, Cameron-Comasco L, Chodosh J, Cooper JJ, Deutsch AL, Elie MC, Elsayem A, Fernandez R, Fleischer-Black J, Gang M, Genes N, Goett R, Heaton H, Hill J, Horwitz L, Isaacs E, Jubanyik K, Lamba S, Lawrence K, Lin M, Loprinzi-Brauer C, Madsen T, Miller J, Modrek A, Otero R, Ouchi K, Richardson C, Richardson LD, Ryan M, Schoenfeld E, Shaw M, Shreves A, Southerland LT, Tan A, Uspal J, Venkat A, Walker L, Wittman I, Zimny E.

2025-02-018 citations

10.1001/jama.2024.23696

Serious illness communication skills training for emergency physicians and advanced practice providers: a multi-method assessment of the reach and effectiveness of the intervention

Oluwaseun Adeyemi, Alexander Ginsburg, Regina Kaur, Allison M. Cuthel, Nicole Zhao et al. (100 authors)

BMC Palliative Care2024-02-204 citations

10.1186/s12904-024-01349-y

Emergency Providers' Knowledge and Attitudes Toward Hospice and Palliative Care: A Cross-Sectional Analysis Across 35 Emergency Departments in the United States

Oluwaseun Adeyemi, Nina Siman, Keith Goldfeld, Allison M. Cuthel, Jean‐Baptiste Bouillon‐Minois et al. (7 authors)

Journal of Palliative Medicine2023-06-016 citations

10.1089/jpm.2022.0545

Effectiveness and Reach of the Primary Palliative Care for Emergency Medicine (PRIM-ER) Pilot Study: a Qualitative Analysis

Frank Chung, Sarah Turecamo, Allison M. Cuthel, Corita R. Grudzen, Benjamin S. Abella et al. (97 authors)

Journal of General Internal Medicine2020-10-279 citations

10.1007/s11606-020-06302-2

Design and implementation of a clinical decision support tool for primary palliative Care for Emergency Medicine (PRIM-ER)

Audrey Tan, Mark D. Durbin, Frank Chung, Ada Rubin, Allison M. Cuthel et al. (15 authors)

BMC Medical Informatics and Decision Making2020-01-2870 citations

10.1186/s12911-020-1021-7

Primary Palliative Care for Emergency Medicine (PRIM-ER): Protocol for a Pragmatic, Cluster-Randomised, Stepped Wedge Design to Test the Effectiveness of Primary Palliative Care Education, Training and Technical Support for Emergency Medicine

Corita R. Grudzen, Abraham A. Brody, Frank Chung, Allison M. Cuthel, David Mann et al. (10 authors)

BMJ Open2019-07-0158 citations

10.1136/bmjopen-2019-030099

Interventions

BEHAVIORALhealthcare service utilization in the six months following the ED visit

The analysis of the effect of PRIM-ER on ED disposition using a generalized linear binomial model with random site level effects.

Study design

Observational model

COHORT

Time perspective

RETROSPECTIVE

Eligibility

Sex/Gender

ALL

Age

66 Years to No maximum

Healthy volunteers

No

Inclusion criteria

* Patients must demonstrate one-year mortality of at least 30 percent (score \> 6) according to the Gagne Index, a validated instrument used to measure all cause one-year mortality in community-dwelling older adults, calculated based on their prior 12 months before the index ED visit of Medicare claims.

Exclusion criteria

* ED patients transferred from a nursing home on the index ED visit will be excluded since prediction of mortality and disposition of such patients differs from community-dwelling adults. * Patients currently receiving hospice at the time of the index ED visit will also be excluded since they have already received services.

Design outcomes

Primary

Measure	Time frame	Description
Acute Care Admission	Index Visit	Proportion of eligible patients whose disposition is to an acute care setting (inpatient, non-palliative service).

Secondary

Measure	Time frame	Description
Inpatient Days	Up to Month 6	Measured as the proportion of patients who had at least one inpatient stay in the six months following the index ED visit (Count).
Home Health Use	Up to Month 6	Proportion of patients with any home health use in the six months following the index ED visit (Yes/No)
Proportion of Patients With Emergency Department (ED) Revisits	Up to Month 6	Measured as the proportion of patients with at least one ED revisit in the six months following the index ED visit (Count)
Proportion of Patients Who Died at Month 6 Post-Index Visit	Up to Month 6	—
Survival: Time-to-event	Up to Month 6	Number of days from index ED visit to death among those who died within six months following the index ED visit (Count of days)
Hospice Use	Up to Month 6	Proportion of patients with any hospice use in the six months following the index ED visit (Yes/No).

Countries

United States

Participant flow

Pre-assignment details

This is an \*\*observational\*\* cluster-randomized \*\*quality improvement (QI) initiative\*\*. Randomization of patients occurred at the ED level; EDs (and subsequent visiting patients) were assigned to either Control (i.e., no intervention) or PRIM-ER (intervention). Medicare claims of the beneficiaries (visiting patients) from index visit and the six months following the index visit were analyzed to assess outcomes. Participant flow data is not analyzed by sequence but rather by arm/condition.

Participants by arm

Arm	Count
Control Care as usual. -ER).	50,458
PRIM-ER Intervention comprising primary palliative care education, training, and technical support for emergency medicine (PRIM-ER).	48,464
Total	98,922

Baseline characteristics

Characteristic	Control	Total	PRIM-ER
Age, Continuous	78.2 years STANDARD_DEVIATION 8.5	78 years STANDARD_DEVIATION 8.4	77.7 years STANDARD_DEVIATION 8.3
Ethnicity (NIH/OMB) Hispanic or Latino	735 Participants	1462 Participants	727 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	49723 Participants	97460 Participants	47737 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) American Indian or Alaska Native	93 Participants	153 Participants	60 Participants
Race (NIH/OMB) Asian	1555 Participants	2788 Participants	1233 Participants
Race (NIH/OMB) Black or African American	6341 Participants	13347 Participants	7006 Participants
Race (NIH/OMB) More than one race	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Unknown or Not Reported	2827 Participants	5684 Participants	2857 Participants
Race (NIH/OMB) White	39642 Participants	76950 Participants	37308 Participants
Region of Enrollment United States	50458 participants	98922 participants	48464 participants
Sex: Female, Male Female	25137 Participants	49041 Participants	23904 Participants
Sex: Female, Male Male	25321 Participants	49881 Participants	24560 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk
deaths Total, all-cause mortality	14,179 / 50,458	13,910 / 48,464
other Total, other adverse events	0 / 0	0 / 0
serious Total, serious adverse events	0 / 0	0 / 0

Outcome results

Primary

Acute Care Admission

Proportion of eligible patients whose disposition is to an acute care setting (inpatient, non-palliative service).

Time frame: Index Visit

Arm	Measure	Value (NUMBER)
Control	Acute Care Admission	0.644 Proportion of participants
PRIM-ER	Acute Care Admission	0.613 Proportion of participants

Secondary

Home Health Use

Proportion of patients with any home health use in the six months following the index ED visit (Yes/No)

Time frame: Up to Month 6

Arm	Measure	Value (NUMBER)
Control	Home Health Use	0.420 Proportion of participants
PRIM-ER	Home Health Use	0.381 Proportion of participants

Secondary

Hospice Use

Proportion of patients with any hospice use in the six months following the index ED visit (Yes/No).

Time frame: Up to Month 6

Arm	Measure	Value (NUMBER)
Control	Hospice Use	0.177 Proportion of participants
PRIM-ER	Hospice Use	0.172 Proportion of participants

Secondary

Inpatient Days

Measured as the proportion of patients who had at least one inpatient stay in the six months following the index ED visit (Count).

Time frame: Up to Month 6

Arm	Measure	Value (NUMBER)
Control	Inpatient Days	0.410 Proportion of participants
PRIM-ER	Inpatient Days	0.366 Proportion of participants

Secondary

Proportion of Patients Who Died at Month 6 Post-Index Visit

Time frame: Up to Month 6

Arm	Measure	Value (NUMBER)
Control	Proportion of Patients Who Died at Month 6 Post-Index Visit	0.281 Proportion of participants
PRIM-ER	Proportion of Patients Who Died at Month 6 Post-Index Visit	0.287 Proportion of participants

Secondary

Proportion of Patients With Emergency Department (ED) Revisits

Measured as the proportion of patients with at least one ED revisit in the six months following the index ED visit (Count)

Time frame: Up to Month 6

Arm	Measure	Value (NUMBER)
Control	Proportion of Patients With Emergency Department (ED) Revisits	0.6 Proportion of Patients
PRIM-ER	Proportion of Patients With Emergency Department (ED) Revisits	0.6 Proportion of Patients

Secondary

Survival: Time-to-event

Number of days from index ED visit to death among those who died within six months following the index ED visit (Count of days)

Time frame: Up to Month 6

Arm	Measure	Value (MEAN)	Dispersion
Control	Survival: Time-to-event	17.3 Days	Standard Deviation 38.8
PRIM-ER	Survival: Time-to-event	17.1 Days	Standard Deviation 37.7

Primary Palliative Care for Emergency Medicine (PRIM-ER)

Conditions

Keywords

Brief summary

Related papers

Interventions

Sponsors

Study design

Eligibility

Inclusion criteria

Exclusion criteria

Design outcomes

Primary

Secondary

Countries

Participant flow

Pre-assignment details

Participants by arm

Baseline characteristics

Adverse events

Outcome results

Acute Care Admission

Home Health Use

Hospice Use

Inpatient Days

Proportion of Patients Who Died at Month 6 Post-Index Visit

Proportion of Patients With Emergency Department (ED) Revisits

Survival: Time-to-event