Heart Failure, Palliative Care
Conditions
Brief summary
This project will develop and test a novel clinical decision support tool (CDS) that encourages timely referral to palliative care for people hospitalized with heart failure. This intervention will incorporate an existing, validated 1-year mortality risk model into a CDS to deliver prognostic information and evidence-based decision support at the point of care. Thus, this research may lead to improved care-concordant and goal-directed care for people with heart failure.
Detailed description
Healthcare providers will encounter the tool during the routine care of their hospitalized patients. Patients randomized to the intervention arm will have providers who receive the tool and can complete one post-trial survey. High rate providers will also have the opportunity to participate in a survey and 1 post-trial interview. Level 2 providers will participate in one interview.
Interventions
BEHAVIORALClinical Decision Support Tool
Deliver prognostic information and evidence-based decision support at the point of care
Sponsors
Yale University
National Heart, Lung, and Blood Institute (NHLBI)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
Eligibility of patients will be assessed automatically by an existing Epic build and will not involve any human intervention. When a provider opens the order entry screen of the patient's medical record, this build will examine the record for all inclusion and exclusion criteria. Those who meet criteria will be automatically enrolled and placed into a randomization group based on the randomization status of their current provider at the time of enrollment. Target sample size is 70 Level 1 providers, 700-1400 participants and 15 Level 2 providers (providers potentially impacted by the tool).
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Healthcare providers must meet the following criteria: * Are an attending physician, fellow, or resident, advanced practice nurse, or physician associate * Has ordering privileges * Are members of one of the hospitals' admitting teams (e.g., hospitalist service, cardiology service) * Anticipate employment at one of the two study sites for the 15-month trial period. Or * Palliative care team member * Hospital administrator/quality and safety personnel Patients of providers enrolled in the study must meet the following criteria for heart failure during hospitalization: * Age 18 years of age or older * N-terminal pro-B-type natriuretic peptide values of \>500 pg/ml * Received intravenous diuretics within 24 hours of admission.
Exclusion criteria
* Pregnant at the time of admission.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Acceptability of Intervention Measure score | up to 15 months | Acceptability of Intervention Measure, 4-item questionnaire. Total score range 1-4. Higher values indicate higher acceptability. |
| Mean Appropriateness of Intervention Measure score | up to 15 months | Appropriateness of Intervention Measure, 4-item questionnaire. Total score range 1-4. Higher values indicate higher appropriateness. |
| Mean Feasibility of Intervention Measure score | up to 15 months | Feasibility of Intervention Measure, 4-item questionnaire. Total score range 1-4. Higher values indicate higher feasibility. |
| Mean System Usability Scale score | up to 15 months | System Usability Scale, 10-item Likert questionnaire. Total score range 0-100. Higher values indicate higher usability |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Participants enrolled in hospice | up to 15 months | Proportion of participants enrolled in hospice during hospitalization |
| Participants readmitted to hospital | up to 15 months | Proportion of participants with 30-day hospital readmission |
| Mean hospital length of stay | up to 15 months | Mean hospital length of stay in days |
| Referral to Specialist Palliative Care | up to 15 months | Proportion of participants who are referred to Specialist Palliative Care |
| Consultation by Specialist Palliative Care | up to 15 months | Proportion of participants who have a completed consultation order by Specialist Palliative Care |
| Advance Care Plan Documentation | up to 15 months | Proportion of participants who have a documented Advance Care Plan |
Countries
United States
Contacts
CONTACTShelli Feder, PhD
CONTACTNathan Wright, MA
PRINCIPAL_INVESTIGATORShelli Feder, PhD
Yale University
Outcome results
None listed