Palliative, Serious Illness
Conditions
Keywords
Palliative Care, Pragmatic Trial
Brief summary
This stepped-wedge, cluster randomized pragmatic trial among 9 MedStar hospitals for patients with serious illness and unmet palliative care (PC) needs will test two interventions embedded within the electronic health record (EHR): (1) a PC needs triggered alert to opt-in to PC consults nudging hospital clinicians to order specialty PC consults for eligible inpatients, and (2) a palliative care needs triggered alert with an opt-out to palliative care consults. The trial will compare the interventions effects to usual care, focusing on completed PC consults during the hospital encounter and other secondary outcomes. The trial also includes an embedded mixed methods study to explore factors influencing the effectiveness and equity of intervention implementation.
Interventions
BEHAVIORALPalliative care needs information
clinician-directed EHR alert providing information about serious illness diagnosis(-es) and unmet palliative care needs
BEHAVIORALDefault consult order
clinician-directed EHR alert providing information about serious illness diagnosis(-es) and unmet palliative care needs + a choice to cancel the default palliative care consult order
Sponsors
University of Pennsylvania
National Institute on Aging (NIA)
Medstar Health Research Institute
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age 18 years or older; AND 2. Admitted to inpatient status at 1 of the 9 participating hospitals 3. Meets validated score threshold of 8 from the MedStar unmet PC needs patient identification algorithm, utilizing empirically-derived weights for each PC need domain within the algorithm.
Exclusion criteria
1. Primary inpatient service: hospice, rehabilitation, psychiatry, obstetrics, neonatal 2. Signed hospital discharge order
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Inpatient palliative care consultation | from enrollment up to 26 weeks | Binary: at least 1 inpatient visit from a PC specialist during the hospital encounter |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospice enrollment | enrollment through 6 months | Binary: hospice enrollment (any level of service) |
| Hospice duration | enrollment through 6 months | Continuous: total days enrolled in hospice (any level of service) |
| Community palliative care referral | enrollment through 6 months | Binary: order for community (home or outpatient clinic) palliative care consultation |
| Hospital all-cause mortality | enrollment to 1 day after hospital discharge | Binary: (primary definition) death in the hospital; (secondary/sensitivity definition) death in the hospital or within 1 calendar day of discharge day. |
| 30-day hospital readmission | hospital discharge through 30 days | Binary: date of admission to an acute care hospital is within 30 days of hospital discharge |
| Number of readmissions | enrollment through 6 months | Count: number of acute care hospital admissions |
| Hospital-free days | Enrollment through 6 months | Count: days from enrollment spent alive and not in an acute care hospital through 6 months or death |
| Change in code status | from enrollment up to 26 weeks | Binary; any change in code status order at enrollment and code status order at hospital discharge |
| Time to palliative care consult | from enrollment up to 26 weeks | Continuous (hours): enrollment to documentation timestamp of first inpatient palliative care consult |
| Discharge to hospice | from enrollment up to 26 weeks | Binary: (primary definition) hospital discharge disposition to hospice (any location or level of service); (secondary/sensitivity analysis definition) hospital discharge disposition to hospice or comfort-focused care orders in-hospital |
| Hospital length of stay | from enrollment up to 26 weeks | Continuous: enrollment time to hospital discharge order timestamp. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORKatherine Courtright, MD, MS
University of Pennsylvania
PRINCIPAL_INVESTIGATORMichael Harhay, PhD, MPH
University of Pennsylvania
Outcome results
None listed