Study of Home-Embedded Palliative Care for Hemodialysis-Dependent End-Stage Renal Disease
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- End-Stage Renal Disease
- Sponsor
- University of Pennsylvania
- Enrollment
- 285
- Locations
- 1
- Primary Endpoint
- Rate of Home Palliative Care Receipt
- Status
- Completed
- Last Updated
- 2 years ago
Overview
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.
Investigators
Scott Halpern
Professor of Medicine
University of Pennsylvania
Eligibility Criteria
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
- Not provided
Outcomes
Primary Outcomes
Rate of Home Palliative Care Receipt
Time Frame: 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 Outcomes
- Hospital-free days(Baseline - 180 days)
- Acceptability of home palliative care referral among clinician stakeholders(Baseline - 180 days)
- Follow-up Home Palliative Care Visits(Baseline - 180 days)
- Mortality(Baseline - 180 days)