Advanced Heart Care At Home

Not Applicable

Active, not recruiting

• Conditions: Heart Failure; Health Care Utilization; Palliative Care; Quality Improvement

• Registration Number: NCT03724695
• Lead Sponsor: University of Pennsylvania

Brief Summary

End-of-life (EOL) care for heart failure (HF) patients includes high healthcare utilization and costs, in part due to the lack of integration of optimal HF management and home-based palliative care. In a pilot quality improvement project of clinician "nudges" to enroll seriously ill HF patients in a home-based, integrated HF and palliative care platform, the investigators demonstrated decreased healthcare utilization and costs and increased hospice utilization among seriously ill HF patients. The investigators propose a pragmatic randomized trial for clinicians of seriously ill HF patients admitted to three University of Pennsylvania Health System Hospitals, randomly assigning an opt-in approach (usual care) versus a "nudge" or opt-out approach of a visit from an Advanced Heart Care at Home (AHCAH) liaison to clinicians of eligible patients to discuss and enroll in the AHCAH program, to rigorously and scientifically evaluate clinical, utilization, and cost outcomes among high-risk HF patients at the EOL, and to promote physician uptake of best practices.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2018-10-28
• Study First Submitted QC: 2018-10-28
• Study First Posted: 2018-10-30
• Study Start: 2018-11-13
• Status Verified: 2024-12
• Last Update Submitted: 2024-12-02
• Last Update Posted: 2024-12-05
• Primary Completion: 2025-12-13
• Study Completion: 2025-12-13

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 700

Inclusion Criteria

1. At least 18 years of age
2. Reside within Caring Way's geographic catchment
3. Heart Failure ICD code from any previous healthcare encounter (inpatient or outpatient) in the 12 months prior to index hospitalization
4. Admitted to a cardiology or hospitalist service
5. Palliative Connect score greater than 0.3
6. Index hospitalization during study period

Exclusion Criteria

1. Less than 18 years of age
2. Pregnant women
3. Incarcerated patients
4. Homeless patients
5. Reside outside of Caring Way's geographic catchment
6. Patients without an identifiable primary physician for AHCAH staff to communicate with as determined by the AHCAH liaison via EPIC
7. Prior hospitalization during study period

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Acute care days	6-12 months	number of hospitalization days in the University of Pennsylvania Health System

Secondary Outcome Measures

Name	Time	Method
Hospice enrollment	6-12 months	number of patients who transition from AHCAH to hospice
Use of intravenous diuretics at home	6-12 months	Prescription and delivery of intravenous diuretics from Penn Home Infusion Therapy Services and administration of intravenous diuretics by AHCAH nurse
hospice length of service	6-12 months	If transitioned to hospice from AHCAH, number of days on hospice
University of Pennsylvania Health System total acute care cost	6-12 months	cost of emergency department visit and/or hospitalization within the UPHS Health system
Pennsylvania total acute care cost	6-12 months	cost of emergency department visit and/or hospitalization within Pennsylvania
University of Pennsylvania Health System number of intensive care unit days	6-12 months	number of days hospitalized in an intensive care unit within UPHS
Mortality	6-12 months	number of patient deaths after enrollment in AHCAH
Pennsylvania number of intensive care unit days	6-12 months	number of days hospitalized in an intensive care unit within hospitals in Pennsylvania
University of Pennsylvania Health System emergency department visits	6-12 months	number of emergency department visits within UPHS
Pennsylvania emergency department visits	6-12 months	number of emergency department visits within hospitals in Pennsylvania
new documentation of goals of care	6-12 months	Advance Care Planning documentation within electronic medical record

Trial Locations

Locations (1)

Perelman Center for Advanced Medicine; 🇺🇸 Philadelphia, Pennsylvania, United States