Randomized Trial of a Home-Advance Care Planning Video Intervention for Patients with Life-limiting Illness

针对生命有限疾病患者的家庭预先护理计划视频干预的随机试验

基本信息

批准号：
10028263
负责人：
Areej El-Jawahri
金额：
$ 40万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-03 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10028263
关键词：
Address Adult Advance Care Planning Caring Chronic Chronic Disease Clinical Clover Communication Complex Consult Consultations Control Groups Country County Decision Aid Decision Making Documentation Effectiveness Electronic Health Record Emotional Ensure Environment Exposure to Foundations Future Goals Health Health system Healthcare Systems Home environment Home visitation Hospitalization Hospitals Infrastructure Inpatients Intervention Knowledge Language Lead Life Medical Medicare New Jersey Nurses Nursing Care Plans Outcome Palliative Care Patient Care Patient Outcomes Assessments Patient-Focused Outcomes Patients Population Predictive Analytics Provider Randomized Clinical Trials Randomized Controlled Trials Research Research Project Grants Resources Resuscitation Services Site Technology Testing Time Training Vulnerable Populations Work base burden of illness care costs care systems comparison intervention cost effectiveness evaluation end of life end of life care ethnic diversity evidence base health literacy hospice environment improved innovation literacy medical specialties outcome forecast palliative patient oriented patient population patient-clinician communication pragmatic trial preference programs racial diversity randomized trial recruit satisfaction success treatment arm treatment as usual visual information

项目摘要

PROJECT SUMMARY/ABSTRACT Overview: The goal of this study is to demonstrate the effectiveness of a home-based advance care planning (ACP) video intervention for improving ACP conversations, resuscitation preference documentation, hospice utilization, and reducing cost of care for patients with life-limiting illness receiving care in the home setting. Background: The number of patients living with serious chronic illness and receiving home-based care through Medicare's House Call Providers program is increasing. Often, these patients lack exposure to specialty palliative care and too frequently receive inpatient palliative care consultations late in the illness trajectory. A large portion of these inpatient specialty palliative care consults are focused exclusively to support ACP documentation, and addressing end-of-life (EOL) care needs for this population. Health care systems require evidence-based ap- proaches that promote these focused palliative care services at home while surmounting challenges such as palliative care workforce shortage. We have developed a video-assisted, home-based ACP intervention (Home- ACP) to improve patient-clinician communication, increase ACP documentation, and lead to more patient-cen- tered and less costly care at the EOL. Home-ACP combines two evidence-based features including 1) predictive analytics to identify patients with an advanced serious illness and a projected prognosis of one year or less; and 2) ACP video decision aid delivered by a nurse as part of Clover Health's House Call Provider program. Our prior work has shown the efficacy of ACP videos in several randomized trials, but have not examined their effect in the home setting. The video is available in 25 languages and scripted at a low literacy level. Research Plan: We propose to conduct a randomized clinical trial of the Home-ACP intervention versus usual care in 500 patients with life-limiting illness and a prognosis of one year or less, receiving home-based care. We will assess the effectiveness of the Home-ACP intervention for preferences for resuscitation, ACP documenta- tion, and hospice utilization. We will also compare patient-reported outcomes in a subset of 200 patients including ACP knowledge, confidence in future care, communication satisfaction, and decisional certainty. Lastly, we will compare the cost of care in the last year of life for patients receiving the Home-ACP intervention versus usual care. Environment: This project will be conducted with the support of the Clover Health House Call Providers pro- gram, which has the resources, infrastructure, and electronic health record capabilities to ensure the success of this trial. Patients will be recruited from 17 counties in New Jersey with substantial ethnic and racial diversity. The investigative research team has the expertise in developing and testing video decision aids and palliative care interventions in large multi-site national trials. Relevance of Research: This project will establish the foundation of a future implementation and dissemination pragmatic trial including tens of thousands of patients in House Call Provider programs across the country.

项目概要/摘要概述：本研究的目的是证明家庭预先护理计划的有效性 (ACP) 视频干预，用于改善 ACP 对话、复苏偏好记录、临终关怀利用率，并降低在家庭环境中接受护理的生命有限疾病患者的护理成本。背景：患有严重慢性病并通过家庭护理接受家庭护理的患者数量医疗保险的上门服务提供者计划正在增加。通常，这些患者缺乏接受专业姑息治疗的机会护理，并且在疾病轨迹后期过于频繁地接受住院姑息治疗咨询。很大一部分这些住院专业姑息治疗咨询的一部分专门用于支持 ACP 文档，以及满足该人群的临终 (EOL) 护理需求。医疗保健系统需要基于证据的应用程序促进这些集中的家庭姑息治疗服务的方法，同时克服诸如姑息治疗劳动力短缺。我们开发了一种视频辅助、基于家庭的 ACP 干预（Home- ACP），以改善患者与临床医生的沟通，增加 ACP 文档，并导致更多以患者为中心的 EOL 的护理费用较低。 Home-ACP 结合了两个基于证据的功能，包括 1) 预测分析以确定患有晚期严重疾病且预计预后为一年或更短时间的患者；和 2) 作为 Clover Health 上门服务提供者计划的一部分，由护士提供 ACP 视频决策辅助。我们的先前的工作已在多项随机试验中显示了 ACP 视频的功效，但尚未检验其效果在家庭环境中。该视频有 25 种语言版本，且脚本语言水平较低。研究计划：我们建议对 Home-ACP 干预与常规干预进行随机临床试验为 500 名患有生命限制性疾病且预后为一年或更短的患者提供家庭护理。我们将评估 Home-ACP 干预对复苏偏好的有效性，ACP 文件化和临终关怀利用。我们还将比较 200 名患者的子集的患者报告结果，包括 ACP 知识、对未来护理的信心、沟通满意度和决策确定性。最后，我们将比较接受 Home-ACP 干预的患者最后一年的护理费用与平时的护理费用关心。环境：该项目将在 Clover Health House Call Providers 的支持下进行 gram，拥有资源、基础设施和电子健康记录功能，可确保成功这次审判。患者将从新泽西州 17 个县招募，这些县具有丰富的民族和种族多样性。调查研究团队拥有开发和测试视频决策辅助和姑息治疗的专业知识大型多中心国家试验中的护理干预措施。研究的相关性：该项目将为未来的实施和传播奠定基础务实的试验包括全国各地上门服务提供者计划中的数万名患者。