Primary Palliative Care for Emergency Medicine (PRIM-ER)

Study Overview
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Brief Summary
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This proposal builds upon the evaluation of Primary Palliative Care Education, Training, and Technical Support for Emergency Medicine (PRIM-ER) implemented in 33 Emergency Departments (EDs). This is a retrospective cohort study that seeks to measure the effect of PRIM-ER on older adults with serious illness on aspects of: 1) ED disposition to an acute setting; 2) healthcare utilization in the 6 months following the index ED visit; 3) survival following the index ED visit; and 4) determine site, provider, and patient-level characteristics that are associated with variation in impact of PRIM-ER across sites.

Official Title
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Primary Palliative Care for Emergency Medicine (PRIM-ER)

Conditions
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Emergencies

Intervention / Treatment
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* Behavioral: healthcare service utilization in the six months following the ED visit


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients must demonstrate one-year mortality of at least 30 percent (score > 6) according to the Gagne Index, a validated instrument used to measure all cause one-year mortality in community-dwelling older adults, calculated based on their prior 12 months before the index ED visit of Medicare claims. Exclusion Criteria: ED patients transferred from a nursing home on the index ED visit will be excluded since prediction of mortality and disposition of such patients differs from community-dwelling adults. Patients currently receiving hospice at the time of the index ED visit will also be excluded since they have already received services.

Ages Eligible for Study
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Minimum Age: 66 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Beneficiaries with a one-year mortality of at least 30%<br>The patient cohort will be extracted via the Centers for Medicare and Medicaid Services (CMS) Research Data Assistance Center (ResDAC) using a two-step process to maximize diversity, and minimize intentional or unintentional exclusions based on risk, age, health literacy, demographics, or expected adherence. | Behavioral: healthcare service utilization in the six months following the ED visit<br>* The analysis of the effect of PRIM-ER on ED disposition using a generalized linear binomial model with random site level effects.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of eligible patients whose disposition is to an acute care setting (inpatient, non-palliative service) | ED disposition will be measured on the index ED visit, and will be a dichotomous variable for an acute care admission (Yes/No). | 6 Months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| healthcare service utilization in the six months following the ED visit and survival times following the ED visit measured by number of home health visits | ED disposition will be measured on the index ED visit | 6 Months | 
| healthcare service utilization in the six months following the ED visit and survival times following the ED visit measured by number of inpatient days (count) | ED disposition will be measured on the index ED visit | 6 Months | 
| healthcare service utilization in the six months following the ED visit and survival times following the ED visit measured by number of admission to an ICU | ED disposition will be measured on the index ED visit | 6 Months | 
| healthcare service utilization in the six months following the ED visit and survival times following the ED visit measured by number of admission to hospice | ED disposition will be measured on the index ED visit | 6 Months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Emergency Department, Palliative Care