Study of Home-Embedded Palliative Care for Hemodialysis- (and Peritoneal-) 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 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

Official Title
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Study of Home-Embedded Palliative Care for Hemodialysis- (and Peritoneal-) Dependent End-Stage Renal Disease (SHEPHERD 2.0)

Conditions
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End-Stage Renal Disease

Intervention / Treatment
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* Behavioral: Nudge for PHPC NP 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 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 home care services 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 Exclusion Criteria: Patients with functional kidney transplants Patients discharged to skilled nursing facilities and LTC facilities

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 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<br>* 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.<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 |
| --- | --- | --- |
| 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 Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | 
| 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 | 
| Time to Home Palliative Care Visit | Days from hospital discharge to the first home palliative care visit. | Baseline - 180 days | 
| Mortality | Mortality rates will be assessed using the electronic health record after the 180-day follow-up period. | Baseline - 180 days | 
| Hospice Enrollment | New hospice enrollment will be assessed using the electronic health record and administrative data for the tristate area. | Baseline - 180 days | 
| Health-Related Quality of Life | Health-related quality of life will be assessed by the EQ-5D survey of patients at 1- and 3-months post-hospital discharge time-points. | 1- and 3-months | 
| Symptom Burden | Symptom burden will be assessed by the Edmonton Symptom Assessment System survey of patients at 1- and 3-months post-hospital discharge time-points. | 1- and 3-months | 
| Quality of Care | Quality of care will be assessed by the CMS-MACRA PC Quality Measures (Received Help for Pain; Felt Heard & Understood) for patients at 1- and 3-months post-hospital discharge time-points. | 1- and 3-months | 

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