Clinical trial NCT04557930: EFFICACY: Hopewell Hospitalist: A Video Game Intervention to Increase Advance Care Planning by Hospitalists
Official title: Hopewell Hospitalist: A Video Game Intervention to Increase Advance Care Planning Conversations by Hospitalists With Older Adults
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Advance Care Planning
Keywords: advance care planning
physician performance
serious games
narrative engagement
Lead sponsor: Dartmouth-Hitchcock Medical Center
Sponsor class: OTHER
Collaborators: name: Sound Physicians
name: National Institute on Aging (NIA)
First posted: 2020-09-22
Enrollment: 163
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Intervention model description: A stepped wedge crossover trial randomizing physician participants at the group level (i.e., hospital). Each hospital group 'crossed over' from control to intervention at a randomized time point.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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 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 pragmatic stepped-wedge crossover phase III trial testing the efficacy of Hopewell Hospitalist for increasing ACP rates measured by ACP billing frequency.

Detailed description: Introduction: Fewer than half of all people in the U.S. have a documented advance care plan, such as an advance directive, despite their importance in ensuring high-quality care at the end-of-life. Hospitalization offers an opportunity for physicians to initiate advance care planning (ACP) conversations. Despite expert recommendations, hospital-based physicians (hospitalists) do not routinely engage in these conversations, reserving them for the critically ill.

The objective of this study is to test the effect of a novel behavioral intervention on the incidence of ACP conversations by hospitalists practicing at a stratified random sample of hospitals drawn from 220 US acute care hospitals staffed by a large, nationwide acute care physician practice with an ongoing ACP quality improvement initiative.

Methods and analysis: We developed Hopewell Hospitalist, a theory-based adventure video game, to modify physicians' attitudes towards ACP conversations, and to increase their motivation for engaging in them. Drawing on the theory of narrative engagement, players assume the persona of Andy Jordan, a hospitalist who accepts a new job in a small town. Through 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 pragmatic stepped-wedge crossover phase III trial, testing the efficacy of Hopewell Hospitalist for increasing ACP conversations. We will randomize 40 hospitals to the month (step) in which they receive the intervention. We aim to recruit 30 hospitalists from up to 8 hospitals each step to complete the intervention, playing Hopewell Hospitalist for at least 2 hours on an iPad pre-loaded with the game. The primary outcome is ACP billing for patients age 65 and older managed by participating hospitalists. We hypothesize that the intervention will increase ACP billing in the quarter after dissemination, and have 80% power to detect a 1% absolute increase and 99% power to detect a 3.5% absolute increase.

Ethics and dissemination: Dartmouth's Committee for the Protection of Human Subjects has approved the study protocol, which is registered on clinicaltrials.gov. We will disseminate the results through manuscripts and the trials website. Hopewell Hospitalist will be made available on the iOS Application Store for download, free of cost, at the conclusion of the trial.

Eligibility criteria: Hospital Inclusion Criteria:

* Value-based delivery model of care (Bundled Payment Care Initiative)
* Staffed by Sound Physicians for at least 2 quarters
* Advance care planning billing rate in prior quarter greater than 0 percent
* Employs a nurse liaison
* Hospitalist chief approval to approach hospitalists

Hospital Exclusion Criteria:

* Sound Physicians no longer staffing the hospital
* Not staffed by Sound Physicians for at least 2 quarters
* Advance care planning billing rate in prior quarter of 0 percent
* Does not employ a nurse liaison
* Hospitalist chief disapproval to approach hospitalists
* Hospitalist chief does not provide contact information for hospitalists
* Target number of hospitalists for the "step" has been met or exceeded

Hospitalist Inclusion Criteria:

* Employed by Sound for at least 2 quarters and staffing an eligible hospital for at least 1 quarter
* ACP billing rate in prior quarter greater than 0 percent or answers eligibility question affirming use of ACP billing codes
* Provides informed consent
* Name matches a name in the contact list for the sample; OR is verified by communication through an employer-based email address
* Receipt of a functional iPad within study step time frame

Hospitalist Exclusion Criteria:

* Not employed by Sound for at least 2 quarters and staffing an eligible hospital for at least 1 quarter
* ACP billing rate in prior quarter of 0 percent or answers eligibility question refusing use of ACP billing
* Does not provide informed consent
* Provides consent after the given deadline for consenting
* Name does not match a name in the contact list for the sample; OR cannot be verified by communication through an employer-based email address
* Receipt of a nonfunctional iPad within study step time frame
* If the number of participants who consent per site exceeds targets, then participants who are part-time employees will be preferentially excluded

Primary outcomes:
measure: Percentage of Patients With Advance Care Planning Bills
timeFrame: 11 months
Secondary outcomes:
measure: Percentage of Patients Who Died While in Hospital
timeFrame: 11 months
measure: Percentage of Patients Readmitted in 7 Days
timeFrame: 11 months
measure: Percentage of Patients Readmitted Within 30-days
timeFrame: 11 months
measure: Percentage of Patients Who Received Critical Care
timeFrame: 11 months
measure: Length of Stay
timeFrame: 11 months
Other outcomes:
Locations:
city: Lebanon
country: United States
facility: Dartmouth Hitchcock Medical Center
state: New Hampshire
Study officials:
affiliation: Dartmouth-Hitchcock Medical Center and Geisel School of Medicine�
name: Amber Barnato, MD, MPH, MS
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Pittsburgh
name: Deepika Mohan, MD, MPH
role: PRINCIPAL_INVESTIGATOR
References:
citation: Mohan D, MacMartin MA, Chelen JSC, Maezes CB, Barnato AE. Development of a theory-based video-game intervention to increase advance care planning conversations by healthcare providers. Implement Sci Commun. 2021 Oct 13;2(1):117. doi: 10.1186/s43058-021-00216-8.
citation: Mohan D, O'Malley AJ, Chelen J, MacMartin M, Murphy M, Rudolph M, Barnato A. Videogame intervention to increase advance care planning conversations by hospitalists with older adults: study protocol for a stepped-wedge clinical trial. BMJ Open. 2021 Mar 22;11(3):e045084. doi: 10.1136/bmjopen-2020-045084.