Palliative Care Population Management Project for Integrated Care Management Program for High-Risk Patients
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Brigham and Women's Hospital
- Enrollment
- 194
- Locations
- 2
- Primary Endpoint
- Percentage of eligible patients with documented goals of care conversations
Study Overview
Brief Summary
The hypothesis of the Serious Illness Care Program (SICP) is that adherence to the Serious Illness Conversation Guide (SICG) portion, the SIGC, will enhance patient understanding and allow control over their own decisions, relieve burdens of decision-making on family members, and help patients achieve a state of peace as they approach the end of life.
Detailed Description
The aim of the Serious Illness Care Program (SICP) is to provide clinicians with an evidence-based structure for eliciting and documenting vital information about preferences for patient driven care of their serious illness. It is designed to help open the door for patients, families, and clinicians to talk and reflect on end-of-life issues in an ongoing way. The hypothesis of the Serious Illness Care Program is that adherence to the conversation guide portion, the SIGC, will enhance patient understanding and allow control over their own decisions, relieve burdens of decision-making on family members, and help patients achieve a state of peace as they approach the end of life. For this protocol specifically, the investigators are testing a pilot intervention of a quality improvement project; the investigators plan to train clinicians and assess the feasibility and impact of the Serious Illness Care Program, which includes patient identification, clinician training, "triggering" of clinicians to conduct the SICG conversation, and documentation, in the iCMP at the Brigham and Women's Hospital.
Study Design
- Study Type
- Interventional
- Allocation
- Non Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Brigham and Women's Hospital or Newton Wellesley Primary Care Clinician at one of the following practices: The Phyllis Jen Center for Primary Care, Faulkner Community Physicians, Brigham and Women's Physician Group, Brigham & Women's Primary Care Associates of Brookline, Brigham Circle Medical Associates, Faulkner
- •Care for patients enrolled in Brigham and Women's Hospital integrated Care Management Program (iCMP)
Exclusion Criteria
- •Resident in Training
- •Non-English Speaking Clinic (e.g. Spanish Clinic)
- •Patient Inclusion Criteria:
- •Over 18 years of age
- •English Speaker
- •Patient at Brigham and Women's Hospital or Newton Wellesley Primary Care Clinician at one of the following practices: The Phyllis Jen Center for Primary Care, Faulkner Community Physicians, Brigham and Women's Physician Group, Brigham & Women's Primary Care Associates of Brookline, Brigham Circle Medical Associates, Faulkner
- •Enrolled in Brigham and Women's Hospital integrated Care Management Program
- •Patient Exclusion Criteria:
- •Patient at Dana-Farber Cancer Institute
Arms & Interventions
Trained Clinicians
Training in Serious Illness Communication Guide
Intervention: Training (Behavioral)
Untrained Clinicians
No training in Serious Illness Communication Guide
Outcomes
Primary Outcomes
Percentage of eligible patients with documented goals of care conversations
Time Frame: from date of determination of eligibility to date of death death during the study period, assessed for up to 18 months
For patients whose death falls during the study period, the percentage of goals of care conversations completed and documented in the electronic medical record by clinicians in the intervention group and the control group. A completed conversation is defined by key elements being documented regarding goals of care in the patient's medical record.
Secondary Outcomes
- Percentage of eligible patients with more comprehensive documentation of goals of care before death(from date of determination of eligibility to date of death during study period, assessed for up to 18 months)
- Median number of days before death of first documented goals of care conversation(from date of determination of eligibility to date of death during the study period, assessed for up to 18 months)
Investigators
Bernacki, Rachelle E.,M.D.
Rachelle Bernacki, M.D., M.S.
Brigham and Women's Hospital