Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
NA
276 participants
INTERVENTIONAL
2014-05-31
2018-12-31
Brief Summary
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Detailed Description
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Conditions
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Study Design
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RANDOMIZED
PARALLEL
HEALTH_SERVICES_RESEARCH
NONE
Study Groups
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CCI Provider for Parent-patient dyad
Parents and patients are randomly assigned to a Continuity Care Intensivist (CCI) Provider who has received specialized communication training. The parent-patient dyad will receive standardized care from the CCI throughout their time in the PICU in addition to being assigned a rotating physician of record.
Continuity Care Intensivist Communication Training
Physicians enrolled in the intervention arm will complete a two to three part communication training. Survey measures of communication competency and burnout will be administered at baseline, after training, and at the end of the study. After the communication training, physicians will undergo an OSCE assessment with a simulated patient to evaluate communication skills. At the end of the study, CCI providers will receive surveys that assess the experience and challenges of the role, repeat surveys assessing competency with communication and frequency of engaging families in goals of care conversations, in addition to a follow-up focus group that will assess their experience with the intervention, the time required and the potential tradeoffs in other duties required by them to participate as a CCI.
Continuity Care Intensivist (CCI) Provider Program
After undergoing CCI training, CCI providers will fulfill a standardized role with parent-patient dyads:
* CCI will meet with families on a regular basis and at change of physician of record throughout their entire PICU hospitalization.
* Help patients/families navigate decisions in concert with preferences and beliefs
* Help patients/families and other care providers look at "bigger picture"; trajectory of illness, goals, and hopes for the patient.
* Serve as point person for active intensivists on service and other specialists
* Help resolve conflict when multiple providers have different opinions on course of action
Usual Care for Parent-patient dyad
Patients and parents randomly assigned to usual care in the PICU which includes the rotation of the physician of record approximately every 7 days. There is no standardized process by which patients may be assigned a primary attending who would follow them throughout their stay. In the usual care arm it may never happen that they are assigned a primary intensivist, regardless of the length of their hospitalization.
No interventions assigned to this group
Interventions
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Continuity Care Intensivist Communication Training
Physicians enrolled in the intervention arm will complete a two to three part communication training. Survey measures of communication competency and burnout will be administered at baseline, after training, and at the end of the study. After the communication training, physicians will undergo an OSCE assessment with a simulated patient to evaluate communication skills. At the end of the study, CCI providers will receive surveys that assess the experience and challenges of the role, repeat surveys assessing competency with communication and frequency of engaging families in goals of care conversations, in addition to a follow-up focus group that will assess their experience with the intervention, the time required and the potential tradeoffs in other duties required by them to participate as a CCI.
Continuity Care Intensivist (CCI) Provider Program
After undergoing CCI training, CCI providers will fulfill a standardized role with parent-patient dyads:
* CCI will meet with families on a regular basis and at change of physician of record throughout their entire PICU hospitalization.
* Help patients/families navigate decisions in concert with preferences and beliefs
* Help patients/families and other care providers look at "bigger picture"; trajectory of illness, goals, and hopes for the patient.
* Serve as point person for active intensivists on service and other specialists
* Help resolve conflict when multiple providers have different opinions on course of action
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
1\. Pediatric Intensive Care Unit Attending Physician who volunteers to serve in the role of CCI.
Usual Care (UC) Provider
1\. Any Pediatric Intensive Care Unit Attending Physician who is not enrolled as a CCI.
Parent-Patient Dyads
1. Parent/guardian of a child who has been admitted to the Children's Hospital of Philadelphia (CHOP) PICU for ≥7 days after onset of the study
2. Parent/guardian ≥ 18 years old
3. Parent/guardian is English-speaking
4. Child \<18 years old at time of enrollment
5. Child has been admitted to the PICU at CHOP for ≥7 days
6. Medical team believed that patient will remain in the PICU for at least another seven days
Exclusion Criteria
1\. Any medical care provider who is not an attending physician (e.g., Pediatric critical care residents, nurses, and fellows)
UC Provider
1. Any medical care provider who is not an attending physician (e.g., Pediatric critical care residents, nurses, and fellows)
2. Attending physician who is enrolled in the study as a CCI
Parent-Patient Dyads
1. Parent or guardian who has previously participated in the CCI study in a previous hospitalization (in either usual care or intervention arm)
2. Parent or guardian of a child who has already been hospitalized in the PICU \>7 days at the onset of the study.
3. Child ≥18 years of age at time of enrollment
4. Child has previously participated in the CCI study in a previous PICU stay (in either usual care or intervention arm)
5. Child has been hospitalized in the PICU \>7 days at the onset of the study
6. Child already has a "primary" attending
7. Child has a sibling that has already been enrolled in the study. This child will be ineligible for the study but will be assigned to the same care as the child who is or was enrolled in the study.
8. If contact was not established for enrollment by 14 days after admission, then the patient was no longer considered eligible for enrollment to maintain comparability of length of stay at enrollment.
ALL
No
Sponsors
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Children's Hospital of Philadelphia
OTHER
Responsible Party
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Principal Investigators
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Jennifer K Walter, MD, PhD, MS
Role: PRINCIPAL_INVESTIGATOR
Children's Hospital of Philadelphia
Locations
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The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Countries
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References
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Other Identifiers
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IRB 14-010987
Identifier Type: -
Identifier Source: org_study_id
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