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

Study Overview
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Brief Summary
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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 physician 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 crossover phase III trial testing the effectiveness of providing physicians with a link to a free version of Hopewell Hospitalist as a means for increasing ACP rates measured by ACP billing frequency.

Official Title
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Hopewell Hospitalist: A Video Game Intervention to Increase Advance Care Planning Conversations by Hospitalists With Older Adults

Conditions
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Advance Care Planning

Intervention / Treatment
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* Behavioral: Hopewell Hospitalist Video Game


Participation Criteria
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Eligibility Criteria
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Hospitalist Inclusion Criteria: Employed by Sound Not previously included in the Efficacy Trial Arm of the study. Hospitalist Exclusion Criteria: Not employed by Sound Does not provide informed consent Previously included in the Efficacy Trial Arm of the study.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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: Sequential Assignment
Interventional Model Description: We will email the Uniform Resource Locator (URL) to download the App with encouragement to play the game, including positive feedback from participants in the efficacy study. Receipt of the email will be our measure of intervention delivery. Each hospitalist 'crosses over' from control to intervention at a single time point.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control: Usual Care<br>The control arm occurs prior to receipt of the video game intervention and reflects usual care. Each hospitalist 'crosses over' from control to intervention at a single time point. | |
| Experimental: Video Game Intervention<br>Each hospitalist 'crosses over' from control to intervention at a single time point by receiving a link to the Hopewell Hospitalist game via email and logging in to play the video game. | Behavioral: Hopewell Hospitalist Video Game<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of Billed Advance Care Planning | Change in physician advance care planning billing for patients over the age of 65 in the three months before and after the roll-out of the video game intervention at their hospital. Advance care planning billing is defined as the presence/absence of ACP charges (Medicare billing codes 99497 or 99498) during a physician's patient's hospitalization. | 6 months (3 months pre and 3 months post intervention) | 
| Merit-based Incentive Payment System Advance Care Planning Quality Score | Change in the Merit-based Incentive Payment System (MIPS) self-report measure of advance care planning by enrolled hospitalists (MiPS-ACP quality score). The MiPS-ACP quality score is the percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. The quality score ranges from 0-100%, with higher scores indicating that a greater proportion of patients with an advance care plan documented in the medical record. | 6 months (3 months pre and 3 months post intervention) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospitalist-Managed Patient In-Hospital Mortality Rate | In-hospital mortality rate for patients managed by enrolled hospitalists. | 6 months (3 months pre and 3 months post intervention) | 
| Hospitalist-Managed Patient 90-Day Mortality Rate | 90-day mortality rate for patients managed by enrolled hospitalists. | 6 months (3 months pre and 3 months post intervention) | 
| Sum of Resources Utilized by Hospitalist-Managed Patients | Combined sum of resources utilized by patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention). It is a composite measure including: admission to ICU, receipt of life-sustaining treatment(s) including mechanical ventilation, placement of tracheostomy, insertion of gastric feeding tube, new onset dialysis. This measure ranges from 0 to 5, where higher scores indicate greater utilization of resources during the index hospitalization. | 6 months (3 months pre and 3 months post intervention) | 
| Incidence of Hospitalist-Managed Patient Admission to ICU | Incidence of admission to ICU for patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention). | 6 months (3 months pre and 3 months post intervention) | 
| Incidence of Hospitalist-Managed Patient Mechanical Ventilation | Incidence of mechanical ventilation of patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention). | 6 months (3 months pre and 3 months post intervention) | 
| Incidence of Hospitalist-Managed Patient Receipt of Life-Sustaining Treatment(s) | Incidence of placement of tracheostomy, insertion of gastric feeding tube, new onset dialysis for patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention). | 6 months (3 months pre and 3 months post intervention) | 
| Hospitalist-Managed Patient Length of Stay | Total days between admission and discharge for patients managed by enrolled hospitalists. | 6 months (3 months pre and 3 months post intervention) | 
| Hospitalist-Managed Patient Disposition Status Type | Type of status upon discharge of patients managed by enrolled hospitalists (e.g., discharged to home, to skilled nursing, to hospice, deceased, etc.). | 6 months (3 months pre and 3 months post intervention) | 
| Hospitalist-Managed Patient 90-Day Episode-Based Spending | Amount of total Medicare payments between index admission and 90-days for patients managed by enrolled hospitalists. | 6 months (3 months pre and 3 months post intervention) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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advance care planning, physician performance, serious games, narrative engagement