Implementation of a Telehealth Palliative Care Model for Persons With Dementia

Not Applicable

Completed

• Conditions: Palliative Care; Dementia
• Interventions: Other: Palliative Care Consultation

• Registration Number: NCT05001620
• Lead Sponsor: University of Maryland, Baltimore

Brief Summary

Grounded in the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) Model, this study will assess the implementation outcomes of the Nurse Practitioner (NP) delivered telehealth Palliative Care Consultation in Post-Acute Care (PCC-PAC) intervention for persons living with dementia (PLWD) and their care-partners newly admitted to nursing homes (NHs) for post-acute care.

Detailed Description

This single arm embedded pragmatic pilot clinical trial will provide data to assess the implementation outcomes of the Nurse Practitioner (NP) delivered telehealth Palliative Care Consultation in Post-Acute Care (PCC-PAC) intervention among 30 persons living with dementia (PLWD) and their care-partners newly admitted to one nursing homes (NH) for post-acute care.

Study Timeline

• Study First Submitted: 2021-07-27
• Study Start: 2021-08-04
• Study First Submitted QC: 2021-08-05
• Study First Posted: 2021-08-12
• Primary Completion: 2023-07-01
• Study Completion: 2023-07-01
• Results First Submitted: 2024-05-17
• Status Verified: 2024-07
• Results First Submitted QC: 2024-07-19
• Last Update Submitted: 2024-07-19
• Results First Posted: 2024-08-13
• Last Update Posted: 2024-08-13

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 16

Inclusion Criteria

Stakeholders:

• (1) PC provider
• (2) Social Work (SW) NH champions
• (3) post-acute care unit nursing staff and providers (including medical directors)
• (4) NH leadership, information technology staff
• (5) PLWD and their care partner(s).

Person Living with Dementia (PLWD)

• documented dementia diagnosis
• admitted for post-acute care
• age ≥ 60 years
• if unable to participate in a conversation or lacking capacity to make healthcare decisions as determined by the NH staff/providers, a care partner who can act as a surrogate decision maker in the PCC-PAC.

Exclusion Criteria

Stakeholders:

-PLWD who receives the intervention

PLWD:

• planned discharge within 48 hours of screening
• currently receiving hospice care

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Palliative Care Consultation in Post-Acute Care	Palliative Care Consultation	Subjects will receive usual care plus a telehealth palliative care consultation by specialty providers who will document their findings in the Electronic Health Record (EHR), and communicate their findings and recommendations to the clinical team.

Primary Outcome Measures

Name	Time	Method
Adherence to Skilled Nursing Facility (SNF)-PCC Recommendations	30 days post admission	Investigators will determine a recommendation adherence score after each participants' encounter. Each recommendation will be assigned 2 points, then will define full (2 points), partial (1 point) and no adherence (0 point) to each recommendation. Investigators will sum the points for each SNF-PCC recommendation and use this as the denominator. Investigators will sum each recommendation with full, partial, no adherence and use this as the numerator. The fraction will be converted to a percentage ranging from 0-100% reflecting the recommendation adherence score.

Secondary Outcome Measures

Name	Time	Method
Number of Hospitalizations	30 days post admission	Number of hospitalization(s)

Trial Locations

Locations (1)

Collingswood Rehabilitation and Healthcare Center; 🇺🇸 Rockville, Maryland, United States