Study of Home-Embedded Palliative Care for Hemodialysis-Dependent End-Stage Renal Disease

Not Applicable

Completed

• Conditions: End-Stage Renal Disease
• Interventions: Behavioral: Nudge for PHPC Referral

• Registration Number: NCT05471622
• Lead Sponsor: University of Pennsylvania

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.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2022-07-20
• Study First Submitted QC: 2022-07-20
• Study Start: 2022-07-21
• Study First Posted: 2022-07-25
• Primary Completion: 2023-06-18
• Study Completion: 2023-12-18
• Status Verified: 2024-02
• Last Update Submitted: 2024-02-19
• Last Update Posted: 2024-02-21

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 285

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

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention	Nudge for PHPC Referral	The lead case manager and covering provider on the inpatient care team for participants in this group will receive a message from the research team identifying their patient as appropriate for home palliative care and will be asked to refer their patient for these services.

Primary Outcome Measures

Name	Time	Method
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 Outcome Measures

Name	Time	Method
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.
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.

Trial Locations

Locations (1)

University of Pennsylvania; 🇺🇸 Philadelphia, Pennsylvania, United States