NCT02858778Unknown不适用
A Randomized Allocation of Palliative Care Consultation in the Emergency Department Compared to Usual Practice
适应症
干预措施
试验速览
- 阶段
- 不适用
- 入组人数
- 120
- 试验地点
- 2
- 主要终点
- The difference in the percentage of patients with a completed advance directive (AD) in Ig vs.Cg
研究概览
简要总结
A prospective randomized controlled trial studying the ordering of palliative care consultations in the emergency department (Ig) versus later palliative care consultations in the hospital--ICU or hospital ward(Cg). Patients will be randomly allocated to Ig or Cg with a 1:1 ratio.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- Double (Participant, Outcomes Assessor)
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Greater than or equal to 65 years old
- •Treated in a resuscitation room for unstable vital signs or respiratory compromise
- •One or more of the following:
- •Advanced or metastatic solid organ cancer
- •End stage organ failure of the heart, lung/COPD, kidney on dialysis, hepatic encephalopathy
- •Suspected sepsis
- •Advanced dementia, end-state multiple sclerosis or Parkinson's disease
- •Status post cardiac arrest with coma (Glascow coma score <7)
- •Patient is from a skilled nursing facility
排除标准
- •Lack decision capacity and have no relative available during ED stay to consent to the study (legally authorized representative-LAR)
- •Enrolled in hospice care prior to randomization
- •A copy of a completed advance directive which names a designated proxy provided physically to the medical team prior to randomization
- •Wearing a DNR bracelet
- •Have been previously enrolled in this study
研究组 & 干预措施
Interventional group (Ig)
Experimental
The interventional group (Ig) will have an early palliative care consultation ordered during their stay in the emergency department.
干预措施: Early order of palliative care consultation (Other)
Control group (Cg)
No Intervention
The control group will be treated as standard of care. Palliative care consultations may or may not be ordered at the attending physician's discretion.
结局指标
主要结局
The difference in the percentage of patients with a completed advance directive (AD) in Ig vs.Cg
时间窗: 1 year
次要结局
- Hospital and ICU length of stay in Ig vs. Cg(1 year)
- Average days in hospice in Ig vs. Cg(1 year)
- Hospital margin contribution for the index visit in Ig vs. Cg(1 year)
- The proportion of billed CMS ACP-CPT codes in Ig vs. Cg(30 days from enrolled patients' hospital discharge)
- Matches of care received to patient-specific preferences in Ig vs. Cg(1 year)
- Patient/family satisfaction with care in Ig vs. Cg(Baseline)
- Amount of hospice referrals in Ig vs. Cg(1 year)
- Time to consultation in Ig vs. Cg groups(1 year)
- Hospital total direct costs for the index visit in Ig vs. Cg(1 year)
研究者
Robert Zalenski
Principle Investigator
Wayne State University
研究点 (2)
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