Clinical trial NCT04296136: Quality Improvement Project for Advance Care Planning Tool in Hospital Medicine
Official title: Quality Improvement Project: Assessing the Use of Advanced Care Planning Documentation for Patients at High Risk of 30-day Mortality on Hospital Medicine Services
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Advance Care Planning
Lead sponsor: Duke University
Sponsor class: OTHER
First posted: 2020-03-05
Enrollment: 743
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: OTHER
Sampling method: NON_PROBABILITY_SAMPLE
Study population: The study population for the QI project will include two groups (pre and post-implementation) in order to evaluate the effectiveness of the program. Both the pre-implementation and the intervention (post-implementation) groups consist of adult patients admitted to the hospital medicine service with a high risk of mortality; clinicians providing care for patients in the post-implementation group will also receive a notification of the patient's high risk of mortality and recommendation for a serious illness conversation. The evaluation has been narrowed to a pre-post study design, which will enable our team to identify the impact of the intervention.

Brief summary: Hospitalized patients and their families are often unprepared regarding end-of-life care. Even patients with high risk of mortality within the index admission or 30 days after admission often do not have clearly defined goals of care. This lack of clarity can create difficult scenarios for patients, their families, and care providers. Lack of communication and documentation of these goals can lead to unnecessary tests, procedures, and readmissions. By creating advanced care planning education for the hospital medicine department, a standardized note template, and EMR utilization for storage and reference of patient's goals of care documentation we aim to facilitate the conveyance of patient's wishes/preferences across different care providers and across separate encounters within the healthcare system. For this study, we will use a pre-post study design to evaluate the implementation of this quality improvement intervention.


Eligibility criteria: Inclusion Criteria:

* All patients admitted to the inpatient medicine service with high risk of mortality.

Exclusion Criteria:

* Involuntary commitment during the index admission

Primary outcomes:
measure: Proportion of patients who have advanced care planning notes completed during the admission
timeFrame: Hospital admission, up to 7 days
measure: Proportion of patients who have advanced care planning notes completed during the admission
timeFrame: Hospital admission, up to 7 days
Secondary outcomes:
measure: Proportion of patient who have documentation utilizing the electronic health record dotphrase note template
timeFrame: Hospital admission, up to 7 days
measure: Proportion of patient who have documentation utilizing the electronic health record dotphrase note template
timeFrame: Hospital admission, up to 7 days
measure: Proportion of patients who are billed for advanced care planning
timeFrame: Hospital admission, up to 7 days
measure: Proportion of patients who are billed for advanced care planning
timeFrame: Hospital admission, up to 7 days
measure: Proportion of patients who receive palliative care consults
timeFrame: Hospital admission, up to 7 days
measure: Proportion of patients who receive palliative care consults
timeFrame: Hospital admission, up to 7 days
measure: Proportion of patients who are discharged to hospice
timeFrame: Hospital discharge, up to 7 days
measure: Proportion of patients who are discharged to hospice
timeFrame: Hospital discharge, up to 7 days
measure: Proportion of patients who have an appointment to the palliative care clinic
timeFrame: Up to 1 month
measure: Proportion of patients who have an appointment to the palliative care clinic
timeFrame: Up to 1 month
Other outcomes:
Locations:
city: Durham
country: United States
facility: Duke University
state: North Carolina
Study officials:
affiliation: Duke University
name: Sendak Mark
role: PRINCIPAL_INVESTIGATOR
References: