Study of Home-Embedded Palliative Care for Hemodialysis- (and Peritoneal-) Dependent End-Stage Renal Disease

NCT06144281 | Terminated

• 1 other identifier: 851328 (2)
• Study Type: interventional
• Target: 315
• Locations: 1 country
• Sites: 1

Brief Summary

Home palliative care needs are often under-recognized in patients with End-Stage Renal Disease (ESRD). This pilot study is designed to evaluate the effectiveness of referrals to home palliative care services in improving patient outcomes compared with usual care among patients with ESRD admitted to a Penn hospital. 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

Conditions

End-Stage Renal Disease

Keywords

palliative; ESRD

Outcome Measures

Primary Outcomes (1)

• Acute Encounters

  A combined count of hospitalizations, Emergency Department, and Observation visits during the 180-day follow-up period that will be assessed using the electronic health record and administrative data for the tri-state area

  Baseline - 180 days

Secondary Outcomes (8)

• Hospital-Free Days

  Baseline - 180 days

• Home Palliative Care Visits

  Baseline - 180 days

• Time to Home Palliative Care Visit

  Baseline - 180 days

• Mortality

  Baseline - 180 days

• Hospice Enrollment

  Baseline - 180 days

Study Arms (2)

Intervention

EXPERIMENTAL

The inpatient care team, including the attending/ordering and covering providers, 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.

Behavioral: Nudge for PHPC NP Referral

Usual Care

NO INTERVENTION

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.

Interventions

Nudge for PHPC NP Referral BEHAVIORAL

The attending and covering providers for inpatients who have been identified according to the study's inclusion criteria as appropriate for home palliative care services upon hospital discharge will be asked to refer their patient for these services.

Intervention

Eligibility Criteria

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

You may qualify if:

• Be an adult (18 years of age or older) hospitalized at a Penn study hospital
• AND digital signature of ESRD (N18.6) within the last 12 months
• AND resides in the five-county area surrounding Philadelphia which is served by Penn Palliative Care Nurse Practitioner program
• AND have one or more of the following markers of potentially unmet needs: (i) existing home care eligibility or referral for home care (but not already receiving PC); (ii) non-ambulatory status determined via nursing assessment; (iii) severe protein-calorie malnutrition; (iv) 2 or more hospitalizations within the prior year

You may not qualify if:

• Patients with functional kidney transplants
• Patients discharged to skilled nursing facilities and LTC facilities

Sponsors & Collaborators

• University of Pennsylvania: lead

Study Sites (1)

University of Pennsylvania

Philadelphia, Pennsylvania, 19104, United States

Location

MeSH Terms

Conditions

Kidney Failure, Chronic

Condition Hierarchy (Ancestors)

Renal Insufficiency, Chronic; Renal Insufficiency; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

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: Professor of Medicine

Study Record Dates

• First Submitted: November 16, 2023
• First Posted: November 22, 2023
• Study Start: December 14, 2023
• Primary Completion: November 11, 2024
• Study Completion: November 11, 2024
• Last Updated: January 27, 2025

Record last verified: 2025-01

Locations

US (1)