Advanced Heart Care At Home

NCT ID: NCT03724695

Last Updated: 2024-12-05

Study Results

Results pending

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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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

700 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-11-13

Study Completion Date

2025-12-13

Brief Summary

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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.

Detailed Description

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Conditions

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Palliative Care Heart Failure Health Care Utilization Quality Improvement

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Control

Usual Care

Group Type NO_INTERVENTION

No interventions assigned to this group

AHCAH Nudge

The investigators have developed methods for sending "nudges" to clinicians via secure text messages to primary teams to alert them that their patient was identified as high-risk for 6-month mortality and that an AHCAH liaison would visit their patient to discuss the AHCAH program and to facilitate enrollment if the patient was amenable. The investigators propose that these secure text messages would be sent to the teams of patients randomized to the intervention by the AHCAH liaison within 72 hours of eligibility identification (to allow for the liaison not being available over the weekend). The investigator team will track all aspects of messaging and timing. Clinicians can choose to opt out a patient from the liaison visit and AHCAH enrollment within a two-hour timeframe.

Group Type EXPERIMENTAL

Clinician nudge or opt out approach for AHCAH liaison visit

Intervention Type OTHER

This study is a "nudge" or opt-out approach of an AHCAH liaison visit to eligible seriously ill HF patients prior to hospital discharge to discuss the AHCAH program and to subsequently facilitate enrolling them in the AHCAH program if they are amenable, compared to the opt-in approach (usual care).

Interventions

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Clinician nudge or opt out approach for AHCAH liaison visit

This study is a "nudge" or opt-out approach of an AHCAH liaison visit to eligible seriously ill HF patients prior to hospital discharge to discuss the AHCAH program and to subsequently facilitate enrolling them in the AHCAH program if they are amenable, compared to the opt-in approach (usual care).

Intervention Type OTHER

Eligibility Criteria

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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
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Penn Medicine Center for Health Care Innovation

UNKNOWN

Sponsor Role collaborator

Independence Blue Cross

OTHER

Sponsor Role collaborator

University of Pennsylvania

OTHER

Sponsor Role lead

Responsible Party

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Scott Halpern

Professor of Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Perelman Center for Advanced Medicine

Philadelphia, Pennsylvania, United States

Site Status

Countries

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United States

References

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Other Identifiers

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831733

Identifier Type: -

Identifier Source: org_study_id