Palliative Care, Dementia
Conditions
Keywords
Dementia, Palliative Care, Telehealth, Nursing Homes
Brief summary
Grounded in the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) Model, this study will assess the implementation outcomes of the Nurse Practitioner (NP) delivered telehealth Palliative Care Consultation in Post-Acute Care (PCC-PAC) intervention for persons living with dementia (PLWD) and their care-partners newly admitted to nursing homes (NHs) for post-acute care.
Detailed description
This single arm embedded pragmatic pilot clinical trial will provide data to assess the implementation outcomes of the Nurse Practitioner (NP) delivered telehealth Palliative Care Consultation in Post-Acute Care (PCC-PAC) intervention among 30 persons living with dementia (PLWD) and their care-partners newly admitted to one nursing homes (NH) for post-acute care.
Interventions
The PC provider conducts the structured PCC-PAC via videoconference or telephone with the PLWD and/or their care partner and the social work (SW) champion in the NH. The SW and PC provider will set up a mutually agreed upon consultation day/time with the PLWD and/or care partner, within 5 business days of NH admission and follow up visits will occur no more than 30 days later (if needed).
Sponsors
National Institute on Aging (NIA)
University of Maryland, Baltimore
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Stakeholders: * (1) PC provider * (2) Social Work (SW) NH champions * (3) post-acute care unit nursing staff and providers (including medical directors) * (4) NH leadership, information technology staff * (5) PLWD and their care partner(s). Person Living with Dementia (PLWD) * documented dementia diagnosis * admitted for post-acute care * age ≥ 60 years * if unable to participate in a conversation or lacking capacity to make healthcare decisions as determined by the NH staff/providers, a care partner who can act as a surrogate decision maker in the PCC-PAC.
Exclusion criteria
Stakeholders: -PLWD who receives the intervention PLWD: * planned discharge within 48 hours of screening * currently receiving hospice care
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Adherence to Skilled Nursing Facility (SNF)-PCC Recommendations | 30 days post admission | Investigators will determine a recommendation adherence score after each participants' encounter. Each recommendation will be assigned 2 points, then will define full (2 points), partial (1 point) and no adherence (0 point) to each recommendation. Investigators will sum the points for each SNF-PCC recommendation and use this as the denominator. Investigators will sum each recommendation with full, partial, no adherence and use this as the numerator. The fraction will be converted to a percentage ranging from 0-100% reflecting the recommendation adherence score. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Hospitalizations | 30 days post admission | Number of hospitalization(s) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Completed Stakeholder Interviews/Focus Groups | 1 year | We engaged participants in focus groups and semi-structured interviews to deepen understanding of barriers and facilitators to telehealth palliative care implementation. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Palliative Care Consultation in Post-Acute Care Subjects will receive usual care plus a telehealth palliative care consultation by specialty providers who will document their findings in the Electronic Health Record (EHR), and communicate their findings and recommendations to the clinical team.
Palliative Care Consultation: The PC provider conducts the structured PCC-PAC via videoconference or telephone with the PLWD and/or their care partner and the social work (SW) champion in the NH. The SW and PC provider will set up a mutually agreed upon consultation day/time with the PLWD and/or care partner, within 5 business days of NH admission and follow up visits will occur no more than 30 days later (if needed). | 2 |
| Stakeholder Engagement We will engage stakeholders in a stakeholder engagement plan that include Palliative Care providers; Social Work (SW) NH champions; post-acute care unit nursing staff and providers (including medial directors); NH leadership, information technology staff; and a PLWD and their care partners in focus groups and one on one semi structured interviews via phone or videoconference. | 14 |
| Total | 16 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Didn't complete the telehealth Palliative Care Consultation | 1 | 0 |
Baseline characteristics
| Characteristic | Palliative Care Consultation in Post-Acute Care | Stakeholder Engagement | Total |
|---|---|---|---|
| Age, Customized >18 years of age | 2 Participants | 14 Participants | 16 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 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 | 1 Participants | 14 Participants | 15 Participants |
| Race (NIH/OMB) White | 1 Participants | 0 Participants | 1 Participants |
| Region of Enrollment United States | 2 participants | 14 participants | 16 participants |
| Sex/Gender, Customized Female | 0 Participants | 0 Participants | 0 Participants |
| Sex/Gender, Customized Male | 1 Participants | 0 Participants | 1 Participants |
| Sex/Gender, Customized Unknown | 1 Participants | 14 Participants | 15 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 2 | 0 / 14 |
| other Total, other adverse events | 0 / 2 | 0 / 14 |
| serious Total, serious adverse events | 0 / 2 | 0 / 14 |
Outcome results
Primary
Adherence to Skilled Nursing Facility (SNF)-PCC Recommendations
Investigators will determine a recommendation adherence score after each participants' encounter. Each recommendation will be assigned 2 points, then will define full (2 points), partial (1 point) and no adherence (0 point) to each recommendation. Investigators will sum the points for each SNF-PCC recommendation and use this as the denominator. Investigators will sum each recommendation with full, partial, no adherence and use this as the numerator. The fraction will be converted to a percentage ranging from 0-100% reflecting the recommendation adherence score.
Time frame: 30 days post admission
Population: no data were collected
Secondary
Number of Hospitalizations
Number of hospitalization(s)
Time frame: 30 days post admission
Population: The one participant that completed the study did not have any hospitalizations. The Stakeholders were not included in the analysis.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Palliative Care Consultation in Post-Acute Care | Number of Hospitalizations | 0 Participants |
| Stakeholder Engagement | Number of Hospitalizations | 0 Participants |
Other Pre-specified
Number of Participants With Completed Stakeholder Interviews/Focus Groups
We engaged participants in focus groups and semi-structured interviews to deepen understanding of barriers and facilitators to telehealth palliative care implementation.
Time frame: 1 year
Population: no arm 1 participants were enrolled in arm 2
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Palliative Care Consultation in Post-Acute Care | Number of Participants With Completed Stakeholder Interviews/Focus Groups | 1 Participants |
| Stakeholder Engagement | Number of Participants With Completed Stakeholder Interviews/Focus Groups | 14 Participants |