Improving the Delivery and Equity of Inpatient Palliative Care: a Hybrid Type I Pragmatic Cluster Trial
试验速览
- 阶段
- 3 期
- 状态
- Enrolling By Invitation
- 入组人数
- 18,000
- 试验地点
- 13
- 主要终点
- Inpatient palliative care consultation
研究概览
简要总结
This stepped-wedge, cluster randomized pragmatic trial among 9 MedStar hospitals for patients with serious illness and unmet palliative care (PC) needs will test two interventions embedded within the electronic health record (EHR): (1) a PC needs triggered alert to opt-in to PC consults nudging hospital clinicians to order specialty PC consults for eligible inpatients, and (2) a palliative care needs triggered alert with an opt-out to palliative care consults. The trial will compare the interventions effects to usual care, focusing on completed PC consults during the hospital encounter and other secondary outcomes. The trial also includes an embedded mixed methods study to explore factors influencing the effectiveness and equity of intervention implementation.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Health Services Research
- 盲法
- Triple (Participant, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age 18 years or older; AND
- •Admitted to inpatient status at 1 of the 9 participating hospitals
- •Meets validated score threshold of 8 from the MedStar unmet PC needs patient identification algorithm, utilizing empirically-derived weights for each PC need domain within the algorithm.
排除标准
- •Primary inpatient service: hospice, rehabilitation, psychiatry, obstetrics, neonatal
- •Signed hospital discharge order
研究组 & 干预措施
Palliative care needs information provision
Clinicians will receive an EHR alert providing information about a patient's serious illness diagnosis(-es) and unmet palliative care needs
干预措施: Palliative care needs information (Behavioral)
Palliative care needs information provision + default consult order
The palliative care needs information provision intervention will be supplemented with a default palliative care consult order such that clinicians will receive an EHR alert providing information about a patient's serious illness diagnosis(-es) and unmet palliative care needs, and offered the choice to cancel the default consult order.
干预措施: Default consult order (Behavioral)
Control/Usual Care
During the control phase, patients meeting eligibility criteria will be enrolled for study data collection but there will be no attempt to influence delivery of care. All hospitals will contribute a minimum of 9 weeks of outcomes data prior to adopting the intervention. The total duration of the control phase will differ for each hospital dependent on their randomly assigned time to adopt Intervention 1 in this stepped-wedge trial design.
结局指标
主要结局
Inpatient palliative care consultation
时间窗: from enrollment up to 26 weeks
Binary: at least 1 inpatient visit from a PC specialist during the hospital encounter
次要结局
- 30-day hospital readmission(hospital discharge through 30 days)
- Number of readmissions(enrollment through 6 months)
- Hospital-free days(Enrollment through 6 months)
- Change in code status(from enrollment up to 26 weeks)
- Time to palliative care consult(from enrollment up to 26 weeks)
- Discharge to hospice(from enrollment up to 26 weeks)
- Hospital length of stay(from enrollment up to 26 weeks)
- Hospice enrollment(enrollment through 6 months)
- Hospice duration(enrollment through 6 months)
- Community palliative care referral(enrollment through 6 months)
- Hospital all-cause mortality(enrollment to 1 day after hospital discharge)
- Community palliative care referral(enrollment through 6 months)
- Hospice enrollment(enrollment through 6 months)
- Hospice duration(enrollment through 6 months)
- Hospital all-cause mortality(enrollment to 1 day after hospital discharge)
- 30-day hospital readmission(hospital discharge through 30 days)
- Number of readmissions(enrollment through 6 months)
- Hospital-free days(Enrollment through 6 months)
- Change in code status(from enrollment up to 26 weeks)
- Time to palliative care consult(from enrollment up to 26 weeks)
- Discharge to hospice(from enrollment up to 26 weeks)
- Hospital length of stay(from enrollment up to 26 weeks)
研究者
Katherine Courtright
Assistant Professor of Medicine
University of Pennsylvania