Clinical trial NCT02258594: Promoting Respect and Ongoing Safety Through Patient-centeredness, Engagement, Communication and Technology
Official title: Transforming the Acute Care Environment: BWH PROSPECT Framework
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Medical Intensive Care Unit (MICU) Patients
Oncology Unit Patients
Lead sponsor: Brigham and Women's Hospital
Sponsor class: OTHER
Collaborators: name: Gordon and Betty Moore Foundation
First posted: 2014-10-07
Enrollment: 4368
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The purpose of this project is to refine, implement, and evaluate a multi-component intervention that achieves sustainable and meaningful impact on healthcare quality, safety, and costs while ensuring dignity and respect for adult oncology and intensive care patients and their care partners. The PROSPECT (Promoting Respect and Ongoing Safety through Patient-centeredness, Engagement, Communication, and Technology) framework will achieve this by enhancing the patient-provider relationship and introducing patient-centered approaches to multi-disciplinary communication and patient education. The PROSPECT framework is based upon a validated structured, team-work training model and novel web-based technology. The overarching goals of this project are to achieve the following:

1. Optimize the overall experience of patients (including their family/care partners) by promoting dignity/respect, encouraging engagement, improving care plan concordance, and enhancing satisfaction.
2. Minimize preventable harms in two environments: intensive care and acute care oncology units.
3. Reduce unnecessary healthcare resource utilization and associated costs.

Detailed description: This overarching project aims are to refine, implement, and evaluate a multi-faceted intervention composed of the Patient-SatisfActive® model, developed by Drs. Ronen Rozenblum and David Bates at Brigham and Women's Hospital, and a web-based Patient-Centered Toolkit (PCTK), developed by Drs. Dykes and Dalal, on quality, safety, and cost outcomes in the intensive care and oncology units at Brigham and Women's Hospital. The specific aims of the project are as follows:

* Aim 1: To refine and implement the Patient-SatisfActive® model to promote respect, dignity, and satisfaction of patients, care partners and staff on intensive care and oncology units.
* Aim 2: To refine and implement a web-based, Patient-Centered Toolkit (PCTK), comprised of an electronic bedside communication center (eBCC) and a patient-centered microblog, to promote tailored patient and care-partner education, communication, collaboration, and engagement.
* Aim 3: To evaluate the relative impact of this intervention compared to usual care on patient reported outcome measures, adverse events (harms), post-discharge healthcare utilization, concordance in understanding the care plan, and satisfaction among care team members (patients/care partners, profession providers).
* Aim 4: To identify the barriers and facilitators of implementing this intervention to support dissemination.

Eligibility criteria: Inclusion Criteria:

* Age \> 18
* Any patient admitted or transferred to designated care units
* Admitted or transferred to a MICU or Oncology service
* On the designated unit for at least 24 hours

Exclusion Criteria:

* Age \< 18
* Any patient admitted or transferred to designated care unit but NOT on a MICU or Oncology service

Primary outcomes:
measure: Preventable Harms (Adverse Events) in the Acute Care Setting
timeFrame: Enrolled patients will be followed for the duration of hospital stay, typically ranging from 5 to 30 days.
Secondary outcomes:
measure: Patient Experience & Satisfaction & Engagement
timeFrame: At time of transfer/discharger from study unit and up to 45-days post-hospitalization
measure: Healthcare Resource Utilization
timeFrame: From time of hospital admission through 30-days post-discharge
measure: Care Plan Concordance
timeFrame: Approximately 48-72 hours after admission to study unit
measure: Perceptions of Communication/Collaboration
timeFrame: Once during baseline (pre-intervention) and post-intervention periods, approximately 12 months
measure: Patient Safety Climate
timeFrame: Once during baseline (pre-intervention) and post-intervention periods, approximately 12 months
measure: Dignity and Respect
timeFrame: At time of transfer/discharger from study unit and up to 45-days post-hospitalization
Other outcomes:
Locations:
city: Boston
country: United States
facility: Brigham and Women's Hospital
state: Massachusetts
Study officials:
affiliation: Brigham and Women's Hospital
name: David W Bates, MD, MSc
role: PRINCIPAL_INVESTIGATOR
affiliation: Brigham and Women's Hospital
name: Patricia Dykes, RN, DNSc
role: STUDY_DIRECTOR
References:
citation: Dalal AK, Dykes P, Samal L, McNally K, Mlaver E, Yoon CS, Lipsitz SR, Bates DW. Potential of an Electronic Health Record-Integrated Patient Portal for Improving Care Plan Concordance during Acute Care. Appl Clin Inform. 2019 May;10(3):358-366. doi: 10.1055/s-0039-1688831. Epub 2019 May 29.
citation: Gazarian PK, Morrison CRC, Lehmann LS, Tamir O, Bates DW, Rozenblum R. Patients' and Care Partners' Perspectives on Dignity and Respect During Acute Care Hospitalization. J Patient Saf. 2021 Aug 1;17(5):392-397. doi: 10.1097/PTS.0000000000000353.