EFFECTIVENESS: Hopewell Hospitalist: A Video Game Intervention to Increase Advance Care Planning by Hospitalists

Not Applicable

Terminated

Conditions: Advance Care Planning

Interventions: Behavioral: Hopewell Hospitalist Video Game

Registration Number: NCT04881968

Lead Sponsor: Dartmouth-Hitchcock Medical Center

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.

Detailed Description: Not available

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 1261

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.

Study & Design

Study Type: INTERVENTIONAL

Study Design: SEQUENTIAL

Arm && Interventions

Group	Intervention	Description
Video Game Intervention	Hopewell Hospitalist Video Game	Each hospitalist 'crosses over' from control to intervention at a single time point by receiving a link to the Hopewell Hospitalist game via email and logging in to play the video game.

Primary Outcome Measures

Name	Time	Method
Incidence of Billed Advance Care Planning	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	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 Outcome Measures

Name	Time	Method
Hospitalist-Managed Patient In-Hospital Mortality Rate	6 months (3 months pre and 3 months post intervention)	In-hospital mortality rate for patients managed by enrolled hospitalists.
Incidence of Hospitalist-Managed Patient Admission to ICU	6 months (3 months pre and 3 months post intervention)	Incidence of admission to ICU for patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
Incidence of Hospitalist-Managed Patient Mechanical Ventilation	6 months (3 months pre and 3 months post intervention)	Incidence of mechanical ventilation of patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
Incidence of Hospitalist-Managed Patient Receipt of Life-Sustaining Treatment(s)	6 months (3 months pre and 3 months post intervention)	Incidence of placement of tracheostomy, insertion of gastric feeding tube, new onset dialysis for patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
Hospitalist-Managed Patient 90-Day Mortality Rate	6 months (3 months pre and 3 months post intervention)	90-day mortality rate for patients managed by enrolled hospitalists.
Sum of Resources Utilized by Hospitalist-Managed Patients	6 months (3 months pre and 3 months post intervention)	Combined sum of resources utilized by patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention). It is a composite measure including: admission to ICU, receipt of life-sustaining treatment(s) including mechanical ventilation, placement of tracheostomy, insertion of gastric feeding tube, new onset dialysis. This measure ranges from 0 to 5, where higher scores indicate greater utilization of resources during the index hospitalization.
Hospitalist-Managed Patient Length of Stay	6 months (3 months pre and 3 months post intervention)	Total days between admission and discharge for patients managed by enrolled hospitalists.
Hospitalist-Managed Patient Disposition Status Type	6 months (3 months pre and 3 months post intervention)	Type of status upon discharge of patients managed by enrolled hospitalists (e.g., discharged to home, to skilled nursing, to hospice, deceased, etc.).
Hospitalist-Managed Patient 90-Day Episode-Based Spending	6 months (3 months pre and 3 months post intervention)	Amount of total Medicare payments between index admission and 90-days for patients managed by enrolled hospitalists.