Project to Improve Communication About Serious Illness--Hospital Study: Pragmatic Trial (Trial 1)

Summary

The objective of this protocol is to test the effectiveness of a Jumpstart intervention on patient-centered outcomes for patients with chronic illness by ensuring that they receive care that is concordant with their goals over time, and across settings and providers. This study will examine the effect of the EHR-based intervention to improve quality of palliative care for patients 55 years or older with chronic, life-limiting illness with a particular emphasis on Alzheimer's disease and related dementias (ADRD). The specific aims are:

1. To evaluate the effectiveness of a novel EHR-based (electronic health record) clinician Jumpstart guide, compared with usual care, for improving the quality of care; the primary outcome is documentation of a goals-of-care discussion in the period between randomization and 30 days following randomization. Secondary outcomes focus on intensity of care: ICU use, ICU and hospital length of stay, costs of care during the hospitalization, and 7 and 30-day hospital readmissions.
2. To conduct a mixed-methods evaluation of the implementation of the intervention, guided by the RE-AIM framework for implementation science, incorporating quantitative evaluation of the intervention's reach and adoption, as well as qualitative analyses of interviews with participants, to explore barriers and facilitators to future implementation and dissemination.

Conditions

• Dementia
• Chronic Disease
• Neoplasm Metastasis
• Lung Neoplasm
• Pulmonary Disease, Chronic Obstructive
• Heart Failure，Congestive
• Liver Cirrhosis
• Kidney Failure, Chronic
• Lung Diseases, Interstitial
• Peripheral Vascular Disease
• Diabetes With End Organ Injury

Interventions

BEHAVIORAL

EHR-based Clinician Jumpstart

The Jumpstart Guide is a communication-priming intervention for clinicians that addresses hospitalized patients' goals of care. The intervention's goal is to prompt clinicians to provide standard of care which includes a discussion with patients or their legal surrogate decision-maker about their goals of care. The one-page Jumpstart Guide provides information to the clinician about prior advance care planning documentation and code status derived from the EHR. The Jumpstart Guides includes tips to improve goals-of-care communication.

Sponsors & Collaborators

• National Institute on Aging (NIA)

  collaborator NIH

• University of Washington

  lead OTHER

Principal Investigators

• Ruth Engelberg, PHD · University of Washington

Study Design

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2020-04-23

Primary Completion

2021-04-26

Completion

2022-09-26

Countries

• United States

Study Locations