Clinical trial NCT03724695: Advanced Heart Care At Home
Official title: Advanced Heart Care At Home (AHCAH); a Pragmatic Randomized Trial for Clinicians Nudged to AHCAH, a Heart Failure Specific Home Palliative Care Services
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: NA
Conditions: Palliative Care
Heart Failure
Health Care Utilization
Quality Improvement
Lead sponsor: University of Pennsylvania
Sponsor class: OTHER
Collaborators: name: Penn Medicine Center for Health Care Innovation
name: Independence Blue Cross
First posted: 2018-10-30
Enrollment: 700
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: End-of-life (EOL) care for heart failure (HF) patients includes high healthcare utilization and costs, in part due to the lack of integration of optimal HF management and home-based palliative care. In a pilot quality improvement project of clinician "nudges" to enroll seriously ill HF patients in a home-based, integrated HF and palliative care platform, the investigators demonstrated decreased healthcare utilization and costs and increased hospice utilization among seriously ill HF patients. The investigators propose a pragmatic randomized trial for clinicians of seriously ill HF patients admitted to three University of Pennsylvania Health System Hospitals, randomly assigning an opt-in approach (usual care) versus a "nudge" or opt-out approach of a visit from an Advanced Heart Care at Home (AHCAH) liaison to clinicians of eligible patients to discuss and enroll in the AHCAH program, to rigorously and scientifically evaluate clinical, utilization, and cost outcomes among high-risk HF patients at the EOL, and to promote physician uptake of best practices.


Eligibility criteria: Inclusion Criteria:

1. At least 18 years of age
2. Reside within Caring Way's geographic catchment
3. Heart Failure ICD code from any previous healthcare encounter (inpatient or outpatient) in the 12 months prior to index hospitalization
4. Admitted to a cardiology or hospitalist service
5. Palliative Connect score greater than 0.3
6. Index hospitalization during study period

Exclusion Criteria:

1. Less than 18 years of age
2. Pregnant women
3. Incarcerated patients
4. Homeless patients
5. Reside outside of Caring Way's geographic catchment
6. Patients without an identifiable primary physician for AHCAH staff to communicate with as determined by the AHCAH liaison via EPIC
7. Prior hospitalization during study period

Primary outcomes:
measure: Acute care days
timeFrame: 6-12 months
Secondary outcomes:
measure: Mortality
timeFrame: 6-12 months
measure: Hospice enrollment
timeFrame: 6-12 months
measure: hospice length of service
timeFrame: 6-12 months
measure: University of Pennsylvania Health System total acute care cost
timeFrame: 6-12 months
measure: Pennsylvania total acute care cost
timeFrame: 6-12 months
measure: University of Pennsylvania Health System number of intensive care unit days
timeFrame: 6-12 months
measure: Pennsylvania number of intensive care unit days
timeFrame: 6-12 months
measure: University of Pennsylvania Health System emergency department visits
timeFrame: 6-12 months
measure: Pennsylvania emergency department visits
timeFrame: 6-12 months
measure: Use of intravenous diuretics at home
timeFrame: 6-12 months
measure: new documentation of goals of care
timeFrame: 6-12 months
Other outcomes:
Locations:
city: Philadelphia
country: United States
facility: Perelman Center for Advanced Medicine
state: Pennsylvania
Study officials:
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