Improving Communication for Primary Care Patients
- Conditions
- DementiaAdvance Care Planning
- Interventions
- Behavioral: SHARING Choices
- Registration Number
- NCT04819191
- Lead Sponsor
- Johns Hopkins University
- Brief Summary
This is a pragmatic trial of SHARING Choices. Components of SHARING Choices include:
1. A letter from the clinic introducing an initiative to prepare persons and families for Advance Care Planning (ACP);
2. Access to a facilitator trained to lead ACP discussions;
3. Patient-family agenda-setting to align perspectives about the role of family and stimulate discussion about ACP;
4. Facilitated registration to the patient portal (for patient and family) as desired;
5. Education \& resources about Alzheimer's Disease and Related Dementias (ADRD) for clinic staff.
- Detailed Description
Engaging family in primary care is particularly important in Alzheimer's Disease and Related Dementias (ADRD) because of the important role assumed in medical decision-making, especially at the end of life. The investigators, study seeks to improve communication in primary care through methods to proactively engage family in ongoing interactions with primary care and stimulate and support Advance Care Planning (ACP) for all older adults and attention to ADRD in primary care throughout the ADRD disease trajectory. The investigators' premise is that individuals and families appreciate primary care involvement in ACP and information and referrals for ADRD needs, but that individual, family, and system factors including time, knowledge, and resources often inhibit these conversations from occurring.
SHARING Choices integrates communication strategies that have been individually found to be effective but have thus far been deployed in isolation of one another. The investigators focus on all older primary care patients because of the importance of addressing ACP early, the under-diagnosis of ADRD and the greater implementation potential of a protocol with broad applicability.
Components of SHARING Choices include:
1. A letter from the clinic introducing an initiative to prepare persons and families for Advance Care Planning (ACP);
2. Access to a facilitator trained to lead ACP discussions;
3. Patient-family agenda-setting to align perspectives about the role of family and stimulate discussion about ACP;
4. Facilitated registration to the patient portal (for patient and family) as desired;
5. Education \& resources about ADRD for clinic staff.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 64915
Practices included in this trial are:
- Affiliated with Johns Hopkins Community Physicians (JHCP) or MedStar Health;
- A primary care practice, defined as adult internal medicine, family medicine, or geriatric medicine;
- Have 2 or more practicing clinicians; and
- Have more than 500 patients aged 65 and over currently receiving care.
Patients included in this trial are:
- Age 65 and older, and
- Established patient of primary care clinician at participating practice (>1 prior visit at the clinic). There will be no formal enrollment of participants into this pragmatic trial as this is a clinic-level initiative that will be available and offered to all eligible patients at clinics randomized to the intervention.
Exclusion criteria:
Primary care practices affiliated with Johns Hopkins Community Physicians (JHCP) or MedStar Health that are:
- Not a primary care practice, defined as adult internal medicine, family medicine, or geriatric medicine;
- Have fewer than 2 practicing clinicians; and
- Have fewer than 500 patients aged 65 and over currently receiving care.
Patients under the care of primary care practices affiliated with Johns Hopkins Community Physicians (JHCP) or MedStar Health that are:
- Less than 65 years of age, or
- Not established patients.
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description SHARING Choices SHARING Choices Components of SHARING Choices include: A letter from the clinic introducing an initiative to prepare persons and families for Advance Care Planning (ACP); Access to a facilitator trained to lead ACP discussions; Patient-family agenda-setting to align perspectives about the role of family and stimulate discussion about ACP; Facilitated registration to the patient portal (for patient and family) as desired; Education \& resources about Alzheimer's Disease and Related Dementias (ADRD) for clinic staff.
- Primary Outcome Measures
Name Time Method Number of Patients 65 and Older With New Documentation of Any Advance Directive in the Electronic Health Record (EHR) 1 year Advance directive will be defined as a durable power of attorney, living will, Maryland Medical Order for Life Sustaining Treatment (MOLST), or District of Columbia Medical Order for Sustaining Treatment (MOST) based on information that is recorded in each care delivery system's electronic medical record 12 months after study entry. The initial visit date for each candidate patient after the inception of the trial serves as the beginning of the 12-month observation period and will be used to construct comparable observation periods for candidate patients at both intervention and control groups.
Occurrence of Potentially Burdensome Procedures Reported Within 6 Months 6 months preceding patient death Potentially burdensome care will be measured as any (yes/no) procedures within the 6 months that precede death using dates and validated International Classification of Diseases (ICD)-10 codes for hospital services that will be extracted from CRISP, the regional health information exchange, which includes a repository of all hospital encounters in Maryland, Delaware, West Virginia, and the District of Columbia. Specific procedures and codes that will be used to reflect burdensome care include intubation and mechanical ventilation, tracheostomy, gastrostomy feeding tube placement, hemodialysis, enteral and parenteral nutrition, and cardiopulmonary resuscitation. Analysis limited to patients with diagnosis codes indicative of serious illness, for whom these procedures would be considered potentially burdensome, drawing from a list of ICD-10 codes.
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (54)
MedStar Medical Group at New Mexico Avenue
🇺🇸Washington, District of Columbia, United States
MedStar Medical Group at Lafayette Centre
🇺🇸Washington, District of Columbia, United States
MedStar Medical Group at Alexandria
🇺🇸Alexandria, Virginia, United States
MedStar Georgetown University Hospital General Internal Medicine
🇺🇸Washington, District of Columbia, United States
MedStar Greater Annapolis Medical Group
🇺🇸Annapolis, Maryland, United States
Johns Hopkins Community Physicians - Remington
🇺🇸Baltimore, Maryland, United States
MedStar Health at Federal Hill
🇺🇸Baltimore, Maryland, United States
MedStar Union Memorial Adult Medicine Specialists at 33rd St.
🇺🇸Baltimore, Maryland, United States
Johns Hopkins Community Physicians - Canton Crossing
🇺🇸Baltimore, Maryland, United States
MedStar Medical Group at Wilkens Center
🇺🇸Baltimore, Maryland, United States
MedStar Medical Group at North Parkville Health Center
🇺🇸Baltimore, Maryland, United States
Family Health Center at MedStar Franklin Square Medical Center
🇺🇸Baltimore, Maryland, United States
MedStar Good Samaritan Hospital Medical Faculty Practice
🇺🇸Baltimore, Maryland, United States
The Primary Care Center at MedStar Franklin Square Medical Center
🇺🇸Baltimore, Maryland, United States
The Center for Successful Aging at MedStar Good Samaritan Hospital
🇺🇸Baltimore, Maryland, United States
MedStar Medical Group at Old Emmorton Rd
🇺🇸Bel Air, Maryland, United States
Johns Hopkins Community Physicians - Downtown Bethesda
🇺🇸Bethesda, Maryland, United States
Johns Hopkins Community Physicians - Water's Edge
🇺🇸Belcamp, Maryland, United States
MedStar Medical Group at Dundalk Professional Center
🇺🇸Dundalk, Maryland, United States
Johns Hopkins Community Physicians - Howard County
🇺🇸Columbia, Maryland, United States
MedStar Medical Group at Dorsey Hall
🇺🇸Ellicott City, Maryland, United States
MedStar Medical Group Primary Care at Fort Washington
🇺🇸Fort Washington, Maryland, United States
MedStar Medical Group at St. Mary's
🇺🇸Leonardtown, Maryland, United States
Johns Hopkins Health Care & Surgery Center - Green Spring Station
🇺🇸Lutherville, Maryland, United States
MedStar Medical Group 18111 Prince Philip
🇺🇸Olney, Maryland, United States
Johns Hopkins Community Physicians - Annapolis
🇺🇸Edgewater, Maryland, United States
Johns Hopkins Community Physicians - Fulton
🇺🇸Fulton, Maryland, United States
Johns Hopkins Community Physicians - Germantown
🇺🇸Germantown, Maryland, United States
Johns Hopkins Community Physicians - Glen Burnie
🇺🇸Glen Burnie, Maryland, United States
MedStar Medical Group at Laurel
🇺🇸Laurel, Maryland, United States
MedStar Medical Group Family Practice at Olney
🇺🇸Olney, Maryland, United States
Johns Hopkins Community Physicians - Hagerstown
🇺🇸Hagerstown, Maryland, United States
MedStar Medical Group at Mitchellville
🇺🇸Mitchellville, Maryland, United States
Johns Hopkins Community Physicians - Odenton
🇺🇸Odenton, Maryland, United States
MedStar Medical Group at Hyattsville
🇺🇸Hyattsville, Maryland, United States
MedStar Medical Group at Honeygo Center
🇺🇸Perry Hall, Maryland, United States
Johns Hopkins Community Physicians - Charles County
🇺🇸White Plains, Maryland, United States
MedStar Medical Group at Silver Spring
🇺🇸Silver Spring, Maryland, United States
Johns Hopkins Community Physicians - I Street
🇺🇸Washington, District of Columbia, United States
Johns Hopkins Bayview Medical Center
🇺🇸Baltimore, Maryland, United States
MedStar Medical Group at Ridge Road
🇺🇸Baltimore, Maryland, United States
MedStar Medical Group at Forest Hill
🇺🇸Forest Hill, Maryland, United States
Johns Hopkins Community Physicians - Frederick
🇺🇸Frederick, Maryland, United States
MedStar Medical Group at St. Clement's
🇺🇸Leonardtown, Maryland, United States
MedStar Medical Group at Olney Professional Park
🇺🇸Olney, Maryland, United States
Johns Hopkins Community Physicians - North Bethesda
🇺🇸Rockville, Maryland, United States
Johns Hopkins Community Physicians - Westminster
🇺🇸Westminster, Maryland, United States
MedStar Medical Group at MedStar Washington Hospital Center
🇺🇸Washington, District of Columbia, United States
MedStar Washington Hospital Center Physician Group LLC
🇺🇸Washington, District of Columbia, United States
MedStar Medical Group at Bethesda
🇺🇸Bethesda, Maryland, United States
Johns Hopkins Community Physicians - Bowie
🇺🇸Bowie, Maryland, United States
MedStar Medical Group at MedStar Health at Brandywine
🇺🇸Brandywine, Maryland, United States
MedStar Medical Group Primary Care at Clinton
🇺🇸Clinton, Maryland, United States
Johns Hopkins Community Physicians - Rockville (Montgomery Grove)
🇺🇸Rockville, Maryland, United States