EFFICACY: Hopewell Hospitalist: A Video Game Intervention to Increase Advance Care Planning by Hospitalists

NCT04557930 | Completed Results DMC

• 2 other identifiers: STUDY00031186P01AG019783
• Study Type: interventional
• Target: 163
• Locations: 1 country
• Sites: 1

Brief Summary

Hopewell Hospitalist is a theory-based adventure video game designed to increase the likelihood that a physician will engage in an advance care planning (ACP) conversation with a patient over the age of 65. Drawing on the theory of narrative engagement, players assume the persona of a hospitalist and navigate a series of clinical encounters with seriously-ill patients over the age of 65. Players experience the consequences of having (or not having) ACP conversations in a timely fashion. The planned study is a pragmatic stepped-wedge crossover phase III trial testing the efficacy of Hopewell Hospitalist for increasing ACP rates measured by ACP billing frequency.

Conditions

Advance Care Planning

Keywords

advance care planning; physician performance; serious games; narrative engagement

Outcome Measures

Primary Outcomes (1)

• Percentage of Patients With Advance Care Planning Bills

  Percentage of advance care planning bills submitted by physicians in the trial for patients over the age of 65 in the period before and after the roll-out of the video game intervention at their hospital. Advance care planning bills are defined as the presence/absence of ACP charges (Medicare billing codes 99497 or 99498) during a patient's hospitalization.

  11 months

Secondary Outcomes (5)

• Percentage of Patients Who Died While in Hospital

  11 months

• Percentage of Patients Readmitted in 7 Days

  11 months

• Percentage of Patients Readmitted Within 30-days

  11 months

• Percentage of Patients Who Received Critical Care

  11 months

• Length of Stay

  11 months

Study Arms (2)

Usual Care Control

NO INTERVENTION

The control arm occurred prior to receipt of the video game intervention. Each hospital group 'crossed over' from control to intervention at a randomized time point based on their assignment to the 'step' of the trial.

Video Game Intervention

EXPERIMENTAL

Each hospital group 'crossed over' from control to intervention at a randomized time point. Physicians working at these hospitals, who agreed to participate in the trial, received a study iPad and were asked to play the video game loaded on the iPad for a minimum of 2 hours.

Behavioral: Hopewell Hospitalist Video Game

Interventions

Hopewell Hospitalist Video Game BEHAVIORAL

Hopewell Hospitalist is a customized theory-based adventure video game that uses narrative engagement to educate physician players on advance care planning to increase physicians' likelihood of engaging in and billing for ACP conversations.

Video Game Intervention

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Value-based delivery model of care (Bundled Payment Care Initiative)
• Staffed by Sound Physicians for at least 2 quarters
• Advance care planning billing rate in prior quarter greater than 0 percent
• Employs a nurse liaison
• Hospitalist chief approval to approach hospitalists

You may not qualify if:

• Sound Physicians no longer staffing the hospital
• Not staffed by Sound Physicians for at least 2 quarters
• Advance care planning billing rate in prior quarter of 0 percent
• Does not employ a nurse liaison
• Hospitalist chief disapproval to approach hospitalists
• Hospitalist chief does not provide contact information for hospitalists
• Target number of hospitalists for the "step" has been met or exceeded
• Employed by Sound for at least 2 quarters and staffing an eligible hospital for at least 1 quarter
• ACP billing rate in prior quarter greater than 0 percent or answers eligibility question affirming use of ACP billing codes
• Provides informed consent
• Name matches a name in the contact list for the sample; OR is verified by communication through an employer-based email address
• Receipt of a functional iPad within study step time frame
• Not employed by Sound for at least 2 quarters and staffing an eligible hospital for at least 1 quarter
• ACP billing rate in prior quarter of 0 percent or answers eligibility question refusing use of ACP billing
• Does not provide informed consent

Sponsors & Collaborators

• Dartmouth-Hitchcock Medical Center: lead
• Sound Physicians: collaborator
• National Institute on Aging (NIA): collaborator

Study Sites (1)

Dartmouth Hitchcock Medical Center

Lebanon, New Hampshire, 03766, United States

Location

Related Publications (3)

• Mohan D, MacMartin MA, Chelen JSC, Maezes CB, Barnato AE. Development of a theory-based video-game intervention to increase advance care planning conversations by healthcare providers. Implement Sci Commun. 2021 Oct 13;2(1):117. doi: 10.1186/s43058-021-00216-8.

  PMID: 34645515 BACKGROUND

• Mohan D, O'Malley AJ, Chelen J, MacMartin M, Murphy M, Rudolph M, Barnato A. Videogame intervention to increase advance care planning conversations by hospitalists with older adults: study protocol for a stepped-wedge clinical trial. BMJ Open. 2021 Mar 22;11(3):e045084. doi: 10.1136/bmjopen-2020-045084.

  PMID: 33753443 BACKGROUND

• Mohan D, O'Malley AJ, Chelen J, MacMartin M, Murphy M, Rudolph M, Engel JA, Barnato AE. Using a Video Game Intervention to Increase Hospitalists' Advance Care Planning Conversations with Older Adults: a Stepped Wedge Randomized Clinical Trial. J Gen Intern Med. 2023 Nov;38(14):3224-3234. doi: 10.1007/s11606-023-08297-y. Epub 2023 Jul 10.

  PMID: 37429972 DERIVED

Limitations and Caveats

Heterogeneity of treatment effect across steps of the trial, suggesting the possibility of confounding secondary to the impact of COVID on hospital conditions. Other limitations include: 1) generalizability of the results; 2) bias from non-random patterns of missingness in the data; 3) failure to systematically evaluate the fidelity and implementation of the intervention as planned due to COVID.

Results Point of Contact

• Title: Dr. Amber E. Barnato
• Organization: Dartmouth-Hitchcock

Amber.Barnato@dartmouth.edu

603-646-5609

Study Officials

• Amber Barnato, MD, MPH, MS

  Dartmouth-Hitchcock Medical Center and Geisel School of Medicine�

  PRINCIPAL INVESTIGATOR

• Deepika Mohan, MD, MPH

  University of Pittsburgh

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: A hospital's treatment assignment was masked during analysis.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Director of the Dartmouth Institute for Health Policy and Clinical Practices

Model Details: A stepped wedge crossover trial randomizing physician participants at the group level (i.e., hospital). Each hospital group 'crossed over' from control to intervention at a randomized time point.

Study Record Dates

• First Submitted: September 11, 2020
• First Posted: September 22, 2020
• Study Start: July 1, 2020
• Primary Completion: May 31, 2021
• Study Completion: August 31, 2021
• Last Updated: April 10, 2023
• Results First Posted: February 28, 2023

Record last verified: 2023-03

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR, ANALYTIC CODE
• Time Frame: Upon publication of the planned manuscripts. Data will be retained through February 2028.
• Access Criteria: Data will require completion of a data use agreement with Dartmouth.

Locations

US (1)