Promoting Respect and Ongoing Safety Through Patient-centeredness, Engagement, Communication and Technology

NCT02258594 | Completed

• 1 other identifier: 2013P001966
• Study Type: interventional
• Target: 4,368
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this project is to refine, implement, and evaluate a multi-component intervention that achieves sustainable and meaningful impact on healthcare quality, safety, and costs while ensuring dignity and respect for adult oncology and intensive care patients and their care partners. The PROSPECT (Promoting Respect and Ongoing Safety through Patient-centeredness, Engagement, Communication, and Technology) framework will achieve this by enhancing the patient-provider relationship and introducing patient-centered approaches to multi-disciplinary communication and patient education. The PROSPECT framework is based upon a validated structured, team-work training model and novel web-based technology. The overarching goals of this project are to achieve the following:

1. 1.Optimize the overall experience of patients (including their family/care partners) by promoting dignity/respect, encouraging engagement, improving care plan concordance, and enhancing satisfaction.
2. 2.Minimize preventable harms in two environments: intensive care and acute care oncology units.
3. 3.Reduce unnecessary healthcare resource utilization and associated costs.

Conditions

Medical Intensive Care Unit (MICU) Patients; Oncology Unit Patients

Outcome Measures

Primary Outcomes (1)

• Preventable Harms (Adverse Events) in the Acute Care Setting

  Preventable adverse events in the acute care setting include medication errors, patient falls, veno-thromboembolism, hospital acquired infection, central line related bloodstream infection, ventilator associated pneumonia, catheter associated urinary tract infection, newly acquired physical harm/injury. We will measure the rate of adverse events acquired from the time of admission to study units through hospital discharge. Using an adaptation of the Institute for Healthcare Improvement (IHI) Global Trigger Tool, we will randomly sample charts of enrolled patients from intervention and control units during the pre-intervention and post-intervention periods to identify adverse events. The length of hospital stay for patients admitted to medical intensive care and oncology units at our institution is variable, typically ranging from 5 to 30 days.

  Enrolled patients will be followed for the duration of hospital stay, typically ranging from 5 to 30 days.

Secondary Outcomes (6)

• Patient Experience & Satisfaction & Engagement

  At time of transfer/discharger from study unit and up to 45-days post-hospitalization

• Healthcare Resource Utilization

  From time of hospital admission through 30-days post-discharge

• Care Plan Concordance

  Approximately 48-72 hours after admission to study unit

• Perceptions of Communication/Collaboration

  Once during baseline (pre-intervention) and post-intervention periods, approximately 12 months

• Patient Safety Climate

  Once during baseline (pre-intervention) and post-intervention periods, approximately 12 months

Study Arms (3)

Baseline - Usual Care

NO INTERVENTION

Usual Care on two Medical Intensive Care Units units Usual Care on four Oncology units

Post-Implementation - Intervention Units

EXPERIMENTAL

PROSPECT Intervention (Web-Based Patient Centered Toolkit (PCTK) + The Patient-SatisfActive® Model) on two MICU units PROSPECT Intervention (Web-Based Patient Centered Toolkit (PCTK) + The Patient-SatisfActive® Model) on two Oncology units

Other: Web-Based Patient Centered Toolkit (PCTK); Behavioral: The Patient-SatisfActive® Model

Post-Implementation - Usual Care

NO INTERVENTION

Usual Care on two Oncology Units

Interventions

Web-Based Patient Centered Toolkit (PCTK) OTHER

The PCTK provides patients/care partners tailored health information regarding conditions, test results, and medications presented at a consumer health literacy level, and the ability to communicate with care team members via "patient-facing" tools accessible from bedside tablet computers. The PCTK allows patients to post questions to their care team members via a patient-centered microblog. The microblog facilitates development of a collaborative patient plan of care. The "provider-facing" PCTK includes tools that engage care team members in 1) completing a safety checklist and viewing a safety dashboard; 2) viewing patient-inputted information (goals, preferences, concerns) regarding the plan of care; 3) identifying clinical problems, care team goals, and patient schedules for education and multidisciplinary communication; 4) messaging patients on the "patient thread"; and 5) discussing patient's plan of care with other providers via the "provider thread".

Post-Implementation - Intervention Units

The Patient-SatisfActive® Model BEHAVIORAL

The Patient-SatisfActive Model is a structured, pro-active, patient-centered care model that aims at improving patient satisfaction by enhancing the degree to which patients' needs, concerns and expectations are met and by preserving dignity and respect. The model comprises steps that enhance interpersonal communication between clinicians and patients, incorporates clinicians' efforts to ascertain, address and document patients' needs, concerns, expectations and perceptions throughout hospitalization, and includes elements that empower and engage patients in their care.

Post-Implementation - Intervention Units

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age \> 18
• Any patient admitted or transferred to designated care units
• Admitted or transferred to a MICU or Oncology service
• On the designated unit for at least 24 hours

You may not qualify if:

• Age \< 18
• Any patient admitted or transferred to designated care unit but NOT on a MICU or Oncology service

Sponsors & Collaborators

• Brigham and Women's Hospital: lead
• Gordon and Betty Moore Foundation: collaborator

Study Sites (1)

Brigham and Women's Hospital

Boston, Massachusetts, 02115, United States

Location

Related Publications (2)

• Dalal AK, Dykes P, Samal L, McNally K, Mlaver E, Yoon CS, Lipsitz SR, Bates DW. Potential of an Electronic Health Record-Integrated Patient Portal for Improving Care Plan Concordance during Acute Care. Appl Clin Inform. 2019 May;10(3):358-366. doi: 10.1055/s-0039-1688831. Epub 2019 May 29.

  PMID: 31141830 DERIVED

• Gazarian PK, Morrison CRC, Lehmann LS, Tamir O, Bates DW, Rozenblum R. Patients' and Care Partners' Perspectives on Dignity and Respect During Acute Care Hospitalization. J Patient Saf. 2021 Aug 1;17(5):392-397. doi: 10.1097/PTS.0000000000000353.

  PMID: 28230575 DERIVED

Study Officials

• David W Bates, MD, MSc

  Brigham and Women's Hospital

  PRINCIPAL INVESTIGATOR

• Patricia Dykes, RN, DNSc

  Brigham and Women's Hospital

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Chief, Division of General Medicine

Study Record Dates

• First Submitted: October 1, 2014
• First Posted: October 7, 2014
• Study Start: March 1, 2013
• Primary Completion: June 1, 2015
• Study Completion: June 1, 2015
• Last Updated: March 14, 2022

Record last verified: 2022-02

Locations

US (1)