Study of Home-Embedded Palliative Care for Hemodialysis-Dependent End-Stage Renal Disease
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 285
- 试验地点
- 2
- 主要终点
- Rate of Home Palliative Care Receipt
研究概览
简要总结
Home palliative care needs are often under-recognized in patients with End-Stage Renal Disease (ESRD). This pilot study is designed to evaluate the feasibility and acceptability of an initiative to enhance referrals to Penn Home Palliative Care compared with usual care among hemodialysis-dependent ESRD patients admitted to a Penn hospital. Results will inform a future pragmatic trial comparing the effectiveness of home palliative care compared with usual care among ESRD patients. Evaluating the effectiveness of home palliative care services is critical to determine whether increasing access to these services would improve patient-centered outcomes for these high-need patients.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Be an adult (18 years of age or older) hospitalized at one of two study hospitals
- •Digital signature of ESRD (N18.6) within the last 12 months with an inpatient hemodialysis order
- •Patient resides in the five-county area surrounding Philadelphia which is served by the Penn Home Palliative Care services.
- •Appropriate for home palliative care, defined as:
- •(i) Existing home care eligibility/referral for home care OR (ii) Severe protein malnutrition (E43, E44) OR (iii) Non-ambulatory status determined by a flowsheet completed by nursing on hospital admission with three ambulatory options: (1) non-ambulatory, (2) ambulates with assistance, or (3) ambulates independently. If this information is missing from the electronic health record, the determination will be made using one of the three following options: (1) overall prior home mobility assessment "complete dependence on all aspects," or (2) ambulation or functional transfers domains indicate "dependent," or (3) wheelchair mobility domain was completed (with any non-null/non-empty value).
排除标准
- 未提供
研究组 & 干预措施
Intervention
The lead case manager and covering provider on the inpatient care team for participants in this group will receive a message from the research team identifying their patient as appropriate for home palliative care and will be asked to refer their patient for these services.
干预措施: Nudge for PHPC Referral (Behavioral)
Usual Care
Participants in this group will receive usual care upon discharge from the hospital. Their clinical team will not be notified that they are appropriate for home palliative care services, but they may still be referred for those services if their clinicians feel their patient will benefit.
结局指标
主要结局
Rate of Home Palliative Care Receipt
时间窗: Baseline - 45 days
Receipt of home palliative care will be defined as at least one home palliative care visit within 45 days after hospital discharge, determined via electronic health record review.
次要结局
- Hospital-free days(Baseline - 180 days)
- Acceptability of home palliative care referral among clinician stakeholders(Baseline - 180 days)
- Follow-up Home Palliative Care Visits(Baseline - 180 days)
- Mortality(Baseline - 180 days)
研究者
Scott Halpern
Professor of Medicine
University of Pennsylvania