Advance Care Planning
Conditions
Keywords
advance care planning, physician performance, serious games, narrative engagement
Brief summary
Hopewell Hospitalist is a theory-based adventure video game designed to increase the likelihood that a physician will engage in an advance care planning (ACP) conversation with a patient over the age of 65. Drawing on the theory of narrative engagement, players assume the persona of a hospitalist physician and navigate a series of clinical encounters with seriously-ill patients over the age of 65. Players experience the consequences of having (or not having) ACP conversations in a timely fashion. The planned study is a crossover phase III trial testing the effectiveness of providing physicians with a link to a free version of Hopewell Hospitalist as a means for increasing ACP rates measured by ACP billing frequency.
Interventions
BEHAVIORALHopewell Hospitalist Video Game
Hopewell Hospitalist is a customized theory-based adventure video game that uses narrative engagement to educate physician players on advance care planning to increase physicians' likelihood of engaging in and billing for ACP conversations.
Sponsors
Sound Physicians
National Institute on Aging (NIA)
Dartmouth-Hitchcock Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Masking description
A physician's treatment assignment will be masked during analysis.
Intervention model description
We will email the Uniform Resource Locator (URL) to download the App with encouragement to play the game, including positive feedback from participants in the efficacy study. Receipt of the email will be our measure of intervention delivery. Each hospitalist 'crosses over' from control to intervention at a single time point.
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
Hospitalist Inclusion Criteria: * Employed by Sound * Not previously included in the Efficacy Trial Arm of the study. Hospitalist
Exclusion criteria
* Not employed by Sound * Does not provide informed consent * Previously included in the Efficacy Trial Arm of the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Merit-based Incentive Payment System Advance Care Planning Quality Score | 6 months (3 months pre and 3 months post intervention) | Change in the Merit-based Incentive Payment System (MIPS) self-report measure of advance care planning by enrolled hospitalists (MiPS-ACP quality score). The MiPS-ACP quality score is the percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. The quality score ranges from 0-100%, with higher scores indicating that a greater proportion of patients with an advance care plan documented in the medical record. |
| Incidence of Billed Advance Care Planning | 6 months (3 months pre and 3 months post intervention) | Change in physician advance care planning billing for patients over the age of 65 in the three months before and after the roll-out of the video game intervention at their hospital. Advance care planning billing is defined as the presence/absence of ACP charges (Medicare billing codes 99497 or 99498) during a physician's patient's hospitalization. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospitalist-Managed Patient 90-Day Mortality Rate | 6 months (3 months pre and 3 months post intervention) | 90-day mortality rate for patients managed by enrolled hospitalists. |
| Sum of Resources Utilized by Hospitalist-Managed Patients | 6 months (3 months pre and 3 months post intervention) | Combined sum of resources utilized by patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention). It is a composite measure including: admission to ICU, receipt of life-sustaining treatment(s) including mechanical ventilation, placement of tracheostomy, insertion of gastric feeding tube, new onset dialysis. This measure ranges from 0 to 5, where higher scores indicate greater utilization of resources during the index hospitalization. |
| Incidence of Hospitalist-Managed Patient Admission to ICU | 6 months (3 months pre and 3 months post intervention) | Incidence of admission to ICU for patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention). |
| Incidence of Hospitalist-Managed Patient Mechanical Ventilation | 6 months (3 months pre and 3 months post intervention) | Incidence of mechanical ventilation of patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention). |
| Hospitalist-Managed Patient Length of Stay | 6 months (3 months pre and 3 months post intervention) | Total days between admission and discharge for patients managed by enrolled hospitalists. |
| Hospitalist-Managed Patient Disposition Status Type | 6 months (3 months pre and 3 months post intervention) | Type of status upon discharge of patients managed by enrolled hospitalists (e.g., discharged to home, to skilled nursing, to hospice, deceased, etc.). |
| Hospitalist-Managed Patient 90-Day Episode-Based Spending | 6 months (3 months pre and 3 months post intervention) | Amount of total Medicare payments between index admission and 90-days for patients managed by enrolled hospitalists. |
| Incidence of Hospitalist-Managed Patient Receipt of Life-Sustaining Treatment(s) | 6 months (3 months pre and 3 months post intervention) | Incidence of placement of tracheostomy, insertion of gastric feeding tube, new onset dialysis for patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention). |
| Hospitalist-Managed Patient In-Hospital Mortality Rate | 6 months (3 months pre and 3 months post intervention) | In-hospital mortality rate for patients managed by enrolled hospitalists. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Hopewell Hospitalist - Apple App Store and Google Analytics | 3 months | Number of unique downloads for the HH game will be provided by the Apple App store. Using Google Analytics we will be able to discern time spent playing the game for each individual hospitalist using their unique log-in passphrase. |
Countries
United States
Participant flow
Pre-assignment details
Individuals who received an invitation via an email from the Chief Experience Officer at Sound Physicians were considered enrolled. In this pre/post study design, each participant would be assigned to both the Control Arm, in which we would analyze ACP billing 90 days prior to the intervention, and the Video Game Intervention Arm, in which we would analyze ACP billing 90 days post intervention.
Participants by arm
| Arm | Count |
|---|---|
| Entire Study Population Each hospitalist in our study population 'crosses over' from control to intervention at a single time point by receiving a link to the Hopewell Hospitalist game via email and logging in to play the video game.
Hopewell Hospitalist Video Game: Hopewell Hospitalist is a customized theory-based adventure video game that uses narrative engagement to educate physician players on advance care planning to increase physicians' likelihood of engaging in and billing for ACP conversations. | 1,261 |
| Total | 1,261 |
Baseline characteristics
| Characteristic | — | Entire Study Population |
|---|---|---|
| Age, Customized We did not collect information regarding age from study participants. | — participants | — |
| Race/Ethnicity, Customized Race/ethnicity | — Participants | — |
| Region of Enrollment United States | — | 1261 participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 0 |
| other Total, other adverse events | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 |
Outcome results
Primary
Incidence of Billed Advance Care Planning
Change in physician advance care planning billing for patients over the age of 65 in the three months before and after the roll-out of the video game intervention at their hospital. Advance care planning billing is defined as the presence/absence of ACP charges (Medicare billing codes 99497 or 99498) during a physician's patient's hospitalization.
Time frame: 6 months (3 months pre and 3 months post intervention)
Population: We are reporting on all study participants in this section. No data was collected for the Primary Outcome: Incidence of Billed Advance Care Planning.
Primary
Merit-based Incentive Payment System Advance Care Planning Quality Score
Change in the Merit-based Incentive Payment System (MIPS) self-report measure of advance care planning by enrolled hospitalists (MiPS-ACP quality score). The MiPS-ACP quality score is the percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. The quality score ranges from 0-100%, with higher scores indicating that a greater proportion of patients with an advance care plan documented in the medical record.
Time frame: 6 months (3 months pre and 3 months post intervention)
Population: We are reporting on all study participants in this section. No data was collected for the Primary Outcome: Merit-based Incentive Payment System Advance Care Planning Quality Score.
Secondary
Hospitalist-Managed Patient 90-Day Episode-Based Spending
Amount of total Medicare payments between index admission and 90-days for patients managed by enrolled hospitalists.
Time frame: 6 months (3 months pre and 3 months post intervention)
Population: We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Hospitalist-Managed Patient 90-Day Episode-Based Spending
Secondary
Hospitalist-Managed Patient 90-Day Mortality Rate
90-day mortality rate for patients managed by enrolled hospitalists.
Time frame: 6 months (3 months pre and 3 months post intervention)
Population: We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Hospitalist-Managed Patient 90-Day Mortality Rate.
Secondary
Hospitalist-Managed Patient Disposition Status Type
Type of status upon discharge of patients managed by enrolled hospitalists (e.g., discharged to home, to skilled nursing, to hospice, deceased, etc.).
Time frame: 6 months (3 months pre and 3 months post intervention)
Population: We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Hospitalist-Managed Patient Disposition Status Type
Secondary
Hospitalist-Managed Patient In-Hospital Mortality Rate
In-hospital mortality rate for patients managed by enrolled hospitalists.
Time frame: 6 months (3 months pre and 3 months post intervention)
Population: We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Hospitalist-Managed Patient In-Hospital Mortality Rate.
Secondary
Hospitalist-Managed Patient Length of Stay
Total days between admission and discharge for patients managed by enrolled hospitalists.
Time frame: 6 months (3 months pre and 3 months post intervention)
Population: We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Hospitalist-Managed Patient Length of Stay
Secondary
Incidence of Hospitalist-Managed Patient Admission to ICU
Incidence of admission to ICU for patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
Time frame: 6 months (3 months pre and 3 months post intervention)
Population: We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Incidence of Hospitalist-Managed Patient Admission to ICU.
Secondary
Incidence of Hospitalist-Managed Patient Mechanical Ventilation
Incidence of mechanical ventilation of patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
Time frame: 6 months (3 months pre and 3 months post intervention)
Population: We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Incidence of Hospitalist-Managed Patient Mechanical Ventilation.
Secondary
Incidence of Hospitalist-Managed Patient Receipt of Life-Sustaining Treatment(s)
Incidence of placement of tracheostomy, insertion of gastric feeding tube, new onset dialysis for patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
Time frame: 6 months (3 months pre and 3 months post intervention)
Population: We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Incidence of Hospitalist-Managed Patient Receipt of Life-Sustaining Treatment(s).
Secondary
Sum of Resources Utilized by Hospitalist-Managed Patients
Combined sum of resources utilized by patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention). It is a composite measure including: admission to ICU, receipt of life-sustaining treatment(s) including mechanical ventilation, placement of tracheostomy, insertion of gastric feeding tube, new onset dialysis. This measure ranges from 0 to 5, where higher scores indicate greater utilization of resources during the index hospitalization.
Time frame: 6 months (3 months pre and 3 months post intervention)
Population: We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Sum of Resources Utilized by Hospitalist-Managed Patients.
Other Pre-specified
Hopewell Hospitalist - Apple App Store and Google Analytics
Number of unique downloads for the HH game will be provided by the Apple App store. Using Google Analytics we will be able to discern time spent playing the game for each individual hospitalist using their unique log-in passphrase.
Time frame: 3 months
Population: We are reporting on all study participants in this section. No data was collected for the Secondary Outcome: Hopewell Hospitalist - Apple App Store and Google Analytics