Advanced Heart Care At Home

Not Applicable

Active, not recruiting

Conditions: Heart Failure
Health Care Utilization
Palliative Care
Quality Improvement

Interventions: Other: Clinician nudge or opt out approach for AHCAH liaison visit

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.

Recruitment & Eligibility

Inclusion Criteria

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

Exclusion Criteria

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

Arm && Interventions

Group	Intervention	Description
AHCAH Nudge	Clinician nudge or opt out approach for AHCAH liaison visit	The investigators have developed methods for sending "nudges" to clinicians via secure text messages to primary teams to alert them that their patient was identified as high-risk for 6-month mortality and that an AHCAH liaison would visit their patient to discuss the AHCAH program and to facilitate enrollment if the patient was amenable. The investigators propose that these secure text messages would be sent to the teams of patients randomized to the intervention by the AHCAH liaison within 72 hours of eligibility identification (to allow for the liaison not being available over the weekend). The investigator team will track all aspects of messaging and timing. Clinicians can choose to opt out a patient from the liaison visit and AHCAH enrollment within a two-hour timeframe.

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

Locations (1): Perelman Center for Advanced Medicine
🇺🇸
Philadelphia, Pennsylvania, United States