Advanced Heart Care at Home (AHCAH); a Pragmatic Randomized Trial for Clinicians Nudged to AHCAH, a Heart Failure Specific Home Palliative Care Services
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- University of Pennsylvania
- Enrollment
- 709
- Locations
- 1
- Primary Endpoint
- Acute care days
Study Overview
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.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
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
Arms & Interventions
Control
Usual Care
AHCAH Nudge
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.
Intervention: Clinician nudge or opt out approach for AHCAH liaison visit (Other)
Outcomes
Primary Outcomes
Acute care days
Time Frame: 6-12 months
number of hospitalization days in the University of Pennsylvania Health System
Secondary Outcomes
- Hospice enrollment(6-12 months)
- Use of intravenous diuretics at home(6-12 months)
- hospice length of service(6-12 months)
- University of Pennsylvania Health System total acute care cost(6-12 months)
- Pennsylvania total acute care cost(6-12 months)
- University of Pennsylvania Health System number of intensive care unit days(6-12 months)
- Mortality(6-12 months)
- Pennsylvania number of intensive care unit days(6-12 months)
- University of Pennsylvania Health System emergency department visits(6-12 months)
- Pennsylvania emergency department visits(6-12 months)
- new documentation of goals of care(6-12 months)
Investigators
Scott Halpern
Professor of Medicine
University of Pennsylvania