Study of Home-Embedded Palliative Care for Hemodialysis- (and Peritoneal-) Dependent End-Stage Renal Disease
- Conditions
- End-Stage Renal Disease
- Interventions
- Behavioral: Nudge for PHPC NP Referral
- Registration Number
- NCT06144281
- 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 effectiveness of referrals to home palliative care services in improving patient outcomes compared with usual care among patients with ESRD admitted to a Penn hospital. 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
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 315
- Be an adult (18 years of age or older) hospitalized at a Penn study hospital
- AND digital signature of ESRD (N18.6) within the last 12 months
- AND resides in the five-county area surrounding Philadelphia which is served by Penn Palliative Care Nurse Practitioner program
- AND have one or more of the following markers of potentially unmet needs: (i) existing home care eligibility or referral for home care (but not already receiving PC); (ii) non-ambulatory status determined via nursing assessment; (iii) severe protein-calorie malnutrition; (iv) 2 or more hospitalizations within the prior year
- Patients with functional kidney transplants
- Patients discharged to skilled nursing facilities and LTC facilities
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention Nudge for PHPC NP Referral The inpatient care team, including the attending/ordering and covering providers, 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 Acute Encounters Baseline - 180 days A combined count of hospitalizations, Emergency Department, and Observation visits during the 180-day follow-up period that will be assessed using the electronic health record and administrative data for the tri-state area
- Secondary Outcome Measures
Name Time Method Hospice Enrollment Baseline - 180 days New hospice enrollment will be assessed using the electronic health record and administrative data for the tristate area.
Symptom Burden 1- and 3-months Symptom burden will be assessed by the Edmonton Symptom Assessment System survey of patients at 1- and 3-months post-hospital discharge time-points.
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.
Mortality Baseline - 180 days Mortality rates will be assessed using the electronic health record after the 180-day follow-up period.
Quality of Care 1- and 3-months Quality of care will be assessed by the CMS-MACRA PC Quality Measures (Received Help for Pain; Felt Heard \& Understood) for patients at 1- and 3-months post-hospital discharge time-points.
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.
Time to Home Palliative Care Visit Baseline - 180 days Days from hospital discharge to the first home palliative care visit.
Health-Related Quality of Life 1- and 3-months Health-related quality of life will be assessed by the EQ-5D survey of patients at 1- and 3-months post-hospital discharge time-points.
Trial Locations
- Locations (1)
University of Pennsylvania
🇺🇸Philadelphia, Pennsylvania, United States