Study of Home-Embedded Palliative Care for Hemodialysis-Dependent End-Stage Renal Disease

Study Overview
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Brief Summary
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Home palliative care needs are often under-recognized in patients with End-Stage Renal Disease (ESRD). This pilot study is designed to evaluate the feasibility and acceptability of an initiative to enhance referrals to Penn Home Palliative Care compared with usual care among hemodialysis-dependent ESRD patients admitted to a Penn hospital. Results will inform a future pragmatic trial comparing the effectiveness of home palliative care compared with usual care among ESRD patients. 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.

Official Title
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Study of Home-Embedded Palliative Care for Hemodialysis-Dependent End-Stage Renal Disease

Conditions
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End-Stage Renal Disease

Intervention / Treatment
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* Behavioral: Nudge for PHPC Referral


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Be an adult (18 years of age or older) hospitalized at one of two study hospitals Digital signature of ESRD (N18.6) within the last 12 months with an inpatient hemodialysis order Patient resides in the five-county area surrounding Philadelphia which is served by the Penn Home Palliative Care services. Appropriate for home palliative care, defined as: (i) Existing home care eligibility/referral for home care OR (ii) Severe protein malnutrition (E43, E44) OR (iii) Non-ambulatory status determined by a flowsheet completed by nursing on hospital admission with three ambulatory options: (1) non-ambulatory, (2) ambulates with assistance, or (3) ambulates independently. If this information is missing from the electronic health record, the determination will be made using one of the three following options: (1) overall prior home mobility assessment complete dependence on all aspects, or (2) ambulation or functional transfers domains indicate dependent, or (3) wheelchair mobility domain was completed (with any non-null/non-empty value). Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>The lead case manager and covering provider on the inpatient care team 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 Referral<br>* The case manager and covering providers for inpatients who have been identified according to the study's inclusion criteria as appropriate for Penn Home Palliative Care (PHPC) upon hospital discharge will be asked to refer their patient for these home palliative care services.<br>|
| No Intervention: Usual Care<br>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. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of Home Palliative Care Receipt | Receipt of home palliative care will be defined as at least one home palliative care visit within 45 days after hospital discharge, determined via electronic health record review. | Baseline - 45 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Follow-up Home Palliative Care Visits | The total number of home palliative care visits during the 180-day follow-up period after hospital discharge will be assessed using the electronic health record. | Baseline - 180 days | 
| Mortality | Mortality rates will be assessed using the electronic health record after the 180-day follow-up period. | Baseline - 180 days | 
| Hospital-free days | The number of hospital-free days during the 180-day follow-up period will be assessed using the electronic health record and administrative data for the tri-state area. | Baseline - 180 days | 
| Acceptability of home palliative care referral among clinician stakeholders | Acceptability of home palliative care referral among clinician stakeholders will be measured via survey and focus group questions. | Baseline - 180 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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palliative, ESRD