End-Stage Renal Disease
Conditions
Keywords
palliative, ESRD
Brief summary
Home palliative care needs are often under-recognized in patients with End-Stage Renal Disease (ESRD). This pilot study is designed to evaluate the feasibility and acceptability of an initiative to enhance referrals to Penn Home Palliative Care compared with usual care among hemodialysis-dependent ESRD patients admitted to a Penn hospital. Results will inform a future pragmatic trial comparing the effectiveness of home palliative care compared with usual care among ESRD patients. Evaluating the effectiveness of home palliative care services is critical to determine whether increasing access to these services would improve patient-centered outcomes for these high-need patients.
Interventions
BEHAVIORALNudge for PHPC Referral
The case manager and covering providers for inpatients who have been identified according to the study's inclusion criteria as appropriate for Penn Home Palliative Care (PHPC) upon hospital discharge will be asked to refer their patient for these home palliative care services.
Sponsors
University of Pennsylvania
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Be an adult (18 years of age or older) hospitalized at one of two study hospitals * Digital signature of ESRD (N18.6) within the last 12 months with an inpatient hemodialysis order * Patient resides in the five-county area surrounding Philadelphia which is served by the Penn Home Palliative Care services. * Appropriate for home palliative care, defined as: (i) Existing home care eligibility/referral for home care OR (ii) Severe protein malnutrition (E43, E44) OR (iii) Non-ambulatory status determined by a flowsheet completed by nursing on hospital admission with three ambulatory options: (1) non-ambulatory, (2) ambulates with assistance, or (3) ambulates independently. If this information is missing from the electronic health record, the determination will be made using one of the three following options: (1) overall prior home mobility assessment complete dependence on all aspects, or (2) ambulation or functional transfers domains indicate dependent, or (3) wheelchair mobility domain was completed (with any non-null/non-empty value).
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Home Palliative Care Receipt | Baseline - 45 days | Receipt of home palliative care will be defined as at least one home palliative care visit within 45 days after hospital discharge, determined via electronic health record review. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Follow-up Home Palliative Care Visits | Baseline - 180 days | The total number of home palliative care visits during the 180-day follow-up period after hospital discharge will be assessed using the electronic health record. |
| Mortality | Baseline - 180 days | Mortality rates will be assessed using the electronic health record after the 180-day follow-up period. |
| Hospital-free days | Baseline - 180 days | The number of hospital-free days during the 180-day follow-up period will be assessed using the electronic health record and administrative data for the tri-state area. |
| Acceptability of home palliative care referral among clinician stakeholders | Baseline - 180 days | Acceptability of home palliative care referral among clinician stakeholders will be measured via survey and focus group questions. |
Countries
United States
Outcome results
None listed