Quality Improvement Project for Advance Care Planning Tool in Hospital Medicine

NCT04296136 | Completed

• 1 other identifier: Pro00104527
• Study Type: observational
• Target: 743
• Locations: 1 country
• Sites: 1

Brief Summary

Hospitalized patients and their families are often unprepared regarding end-of-life care. Even patients with high risk of mortality within the index admission or 30 days after admission often do not have clearly defined goals of care. This lack of clarity can create difficult scenarios for patients, their families, and care providers. Lack of communication and documentation of these goals can lead to unnecessary tests, procedures, and readmissions. By creating advanced care planning education for the hospital medicine department, a standardized note template, and EMR utilization for storage and reference of patient's goals of care documentation we aim to facilitate the conveyance of patient's wishes/preferences across different care providers and across separate encounters within the healthcare system. For this study, we will use a pre-post study design to evaluate the implementation of this quality improvement intervention.

Conditions

Advance Care Planning

Outcome Measures

Primary Outcomes (2)

• Proportion of patients who have advanced care planning notes completed during the admission

  As measured by medical record review (Pre-implementation)

  Hospital admission, up to 7 days

• Proportion of patients who have advanced care planning notes completed during the admission

  As measured by medical record review (Post-implementation)

  Hospital admission, up to 7 days

Secondary Outcomes (10)

• Proportion of patient who have documentation utilizing the electronic health record dotphrase note template

  Hospital admission, up to 7 days

• Proportion of patient who have documentation utilizing the electronic health record dotphrase note template

  Hospital admission, up to 7 days

• Proportion of patients who are billed for advanced care planning

  Hospital admission, up to 7 days

• Proportion of patients who are billed for advanced care planning

  Hospital admission, up to 7 days

• Proportion of patients who receive palliative care consults

  Hospital admission, up to 7 days

Study Arms (2)

High risk of mortality

Adult patients admitted to the hospital medicine service with a high risk of mortality

Other: Advance Care Planning Discussion

High risk of mortality (pre-implementation)

Adult patients admitted to the hospital medicine service with a high risk of mortality

Interventions

Advance Care Planning Discussion OTHER

Goals of care discussion with patient, documentation with electronic health record note and advance care planning billing. This will also include: pharmacy review of medications, case management review, and coding specialist review.

High risk of mortality

Eligibility Criteria

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

Study Population

The study population for the QI project will include two groups (pre and post-implementation) in order to evaluate the effectiveness of the program. Both the pre-implementation and the intervention (post-implementation) groups consist of adult patients admitted to the hospital medicine service with a high risk of mortality; clinicians providing care for patients in the post-implementation group will also receive a notification of the patient's high risk of mortality and recommendation for a serious illness conversation. The evaluation has been narrowed to a pre-post study design, which will enable our team to identify the impact of the intervention.

You may qualify if:

• All patients admitted to the inpatient medicine service with high risk of mortality.

You may not qualify if:

• Involuntary commitment during the index admission

Sponsors & Collaborators

• Duke University: lead

Study Sites (1)

Duke University

Durham, North Carolina, 27705, United States

Location

Study Officials

• Sendak Mark

  Duke University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: OTHER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 3, 2020
• First Posted: March 5, 2020
• Study Start: November 26, 2019
• Primary Completion: September 15, 2021
• Study Completion: March 15, 2022
• Last Updated: May 18, 2022

Record last verified: 2022-05

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)