Hopewell Hospitalist: A Video Game Intervention to Increase Advance Care Planning Conversations by Hospitalists With Older Adults
Trial Snapshot
- Phase
- Not Applicable
- Status
- Terminated
- Enrollment
- 1,261
- Locations
- 2
- Primary Endpoint
- Incidence of Billed Advance Care Planning
Study Overview
Brief Summary
Hopewell Hospitalist is a theory-based adventure video game designed to increase the likelihood that a physician will engage in an advance care planning (ACP) conversation with a patient over the age of 65. Drawing on the theory of narrative engagement, players assume the persona of a hospitalist physician and navigate a series of clinical encounters with seriously-ill patients over the age of 65. Players experience the consequences of having (or not having) ACP conversations in a timely fashion. The planned study is a crossover phase III trial testing the effectiveness of providing physicians with a link to a free version of Hopewell Hospitalist as a means for increasing ACP rates measured by ACP billing frequency.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Sequential
- Primary Purpose
- Health Services Research
- Masking
- Single (Outcomes Assessor)
Masking Description
A physician's treatment assignment will be masked during analysis.
Eligibility Criteria
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Employed by Sound
- •Not previously included in the Efficacy Trial Arm of the study.
- •Hospitalist
Exclusion Criteria
- •Not employed by Sound
- •Does not provide informed consent
- •Previously included in the Efficacy Trial Arm of the study.
Outcomes
Primary Outcomes
Incidence of Billed Advance Care Planning
Time Frame: 6 months (3 months pre and 3 months post intervention)
Change in physician advance care planning billing for patients over the age of 65 in the three months before and after the roll-out of the video game intervention at their hospital. Advance care planning billing is defined as the presence/absence of ACP charges (Medicare billing codes 99497 or 99498) during a physician's patient's hospitalization.
Merit-based Incentive Payment System Advance Care Planning Quality Score
Time Frame: 6 months (3 months pre and 3 months post intervention)
Change in the Merit-based Incentive Payment System (MIPS) self-report measure of advance care planning by enrolled hospitalists (MiPS-ACP quality score). The MiPS-ACP quality score is the percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. The quality score ranges from 0-100%, with higher scores indicating that a greater proportion of patients with an advance care plan documented in the medical record.
Secondary Outcomes
- Hospitalist-Managed Patient In-Hospital Mortality Rate(6 months (3 months pre and 3 months post intervention))
- Incidence of Hospitalist-Managed Patient Admission to ICU(6 months (3 months pre and 3 months post intervention))
- Incidence of Hospitalist-Managed Patient Mechanical Ventilation(6 months (3 months pre and 3 months post intervention))
- Incidence of Hospitalist-Managed Patient Receipt of Life-Sustaining Treatment(s)(6 months (3 months pre and 3 months post intervention))
- Hospitalist-Managed Patient 90-Day Mortality Rate(6 months (3 months pre and 3 months post intervention))
- Sum of Resources Utilized by Hospitalist-Managed Patients(6 months (3 months pre and 3 months post intervention))
- Hospitalist-Managed Patient Length of Stay(6 months (3 months pre and 3 months post intervention))
- Hospitalist-Managed Patient Disposition Status Type(6 months (3 months pre and 3 months post intervention))
- Hospitalist-Managed Patient 90-Day Episode-Based Spending(6 months (3 months pre and 3 months post intervention))
Investigators
Amber Barnato
Susan J. and Richard M. Levy 1960 Distinguished Professor in Health Care Delivery
Dartmouth-Hitchcock Medical Center