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 effectiveness of referrals to home palliative care services in improving patient outcomes compared with usual care among patients with ESRD admitted to a Penn hospital. 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 NP Referral
The attending and covering providers for inpatients who have been identified according to the study's inclusion criteria as appropriate for home palliative care services upon hospital discharge will be asked to refer their patient for these 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 a Penn study hospital * AND digital signature of ESRD (N18.6) within the last 12 months * AND resides in the five-county area surrounding Philadelphia which is served by Penn Palliative Care Nurse Practitioner program * AND have one or more of the following markers of potentially unmet needs: (i) existing home care eligibility or referral for home care (but not already receiving PC); (ii) non-ambulatory status determined via nursing assessment; (iii) severe protein-calorie malnutrition; (iv) 2 or more hospitalizations within the prior year
Exclusion criteria
* Patients with functional kidney transplants * Patients discharged to skilled nursing facilities and LTC facilities
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Acute Encounters | Baseline - 180 days | A combined count of hospitalizations, Emergency Department, and Observation visits during the 180-day follow-up period that will be assessed using the electronic health record and administrative data for the tri-state area |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 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. |
| Time to Home Palliative Care Visit | Baseline - 180 days | Days from hospital discharge to the first home palliative care visit. |
| 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. |
| Health-Related Quality of Life | 1- and 3-months | Health-related quality of life will be assessed by the EQ-5D survey of patients at 1- and 3-months post-hospital discharge time-points. |
| Symptom Burden | 1- and 3-months | Symptom burden will be assessed by the Edmonton Symptom Assessment System survey of patients at 1- and 3-months post-hospital discharge time-points. |
| Quality of Care | 1- and 3-months | Quality of care will be assessed by the CMS-MACRA PC Quality Measures (Received Help for Pain; Felt Heard & Understood) for patients at 1- and 3-months post-hospital discharge time-points. |
| Hospice Enrollment | Baseline - 180 days | New hospice enrollment will be assessed using the electronic health record and administrative data for the tristate area. |
Countries
United States
Outcome results
None listed