Primary Palliative Care for Emergency Medicine (PRIM-ER)

Active, not recruiting

• Conditions: Emergencies
• Interventions: Behavioral: healthcare service utilization in the six months following the ED visit

• Registration Number: NCT03424109
• Lead Sponsor: NYU Langone Health

Brief Summary

This proposal builds upon the evaluation of Primary Palliative Care Education, Training, and Technical Support for Emergency Medicine (PRIM-ER) implemented in 33 Emergency Departments (EDs). This is a retrospective cohort study that seeks to measure the effect of PRIM-ER on older adults with serious illness on aspects of: 1) ED disposition to an acute setting; 2) healthcare utilization in the 6 months following the index ED visit; 3) survival following the index ED visit; and 4) determine site, provider, and patient-level characteristics that are associated with variation in impact of PRIM-ER across sites.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2018-01-30
• Study First Submitted QC: 2018-02-05
• Study First Posted: 2018-02-06
• Study Start: 2019-07-01
• Primary Completion: 2023-06-01
• Status Verified: 2024-10
• Last Update Submitted: 2024-10-31
• Last Update Posted: 2024-11-04
• Study Completion: 2025-06-30

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 57717

Inclusion Criteria

• Patients must demonstrate one-year mortality of at least 30 percent (score > 6) according to the Gagne Index, a validated instrument used to measure all cause one-year mortality in community-dwelling older adults, calculated based on their prior 12 months before the index ED visit of Medicare claims.

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Exclusion Criteria

• ED patients transferred from a nursing home on the index ED visit will be excluded since prediction of mortality and disposition of such patients differs from community-dwelling adults.
• Patients currently receiving hospice at the time of the index ED visit will also be excluded since they have already received services.

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Beneficiaries with a one-year mortality of at least 30%	healthcare service utilization in the six months following the ED visit	The patient cohort will be extracted via the Centers for Medicare and Medicaid Services (CMS) Research Data Assistance Center (ResDAC) using a two-step process to maximize diversity, and minimize intentional or unintentional exclusions based on risk, age, health literacy, demographics, or expected adherence.

Primary Outcome Measures

Name	Time	Method
Acute care admission	Index Visit	Will be measured on the index ED visit, and will be a dichotomous variable for an acute care admission (Yes/No).

Secondary Outcome Measures

Name	Time	Method
ED revisits	6 Months	Will be measured as the number of ED revisits in the six months following the index ED visit (Count).
Survival	6 Months	Will be measured as a dichotomous variable for death in the six months following the index ED visit (Yes/No)
Hospice use	6 Months	Will be measured as a dichotomous variable for any hospice use in the six months following the index ED visit (Yes/No)
Survival: Time-to-event	6 Months	Will be measured as the number of days from index ED visit to death among those who died within six months following the index ED visit (Count of days)
Inpatient days	6 Months	Will be measured as the number of inpatient stays in the six months following the index ED visit (Count)
Home health use	6 Months	Will be measured as a dichotomous variable for any home health use in the six months following the index ED visit (Yes/No)

Trial Locations

Locations (1)

New York University School of Medicine; 🇺🇸 New York, New York, United States