Quality Improvement Project for Advance Care Planning Tool in Hospital Medicine

Advance Care Planning Clinical Trial

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04296136
• Other study ID #: Pro00104527
• Status: Completed
• Start date: November 26, 2019
• Est. completion date: March 15, 2022

Study information

• Verified date: May 2022
• Source: Duke University
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial 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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 743
• Est. completion date: March 15, 2022
• Est. primary completion date: September 15, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

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

Exclusion Criteria:

• Involuntary commitment during the index admission

Related Conditions & MeSH terms

• Advance Care Planning

Intervention

Other:
• Advance Care Planning Discussion
Goals of care discussion with patient, documentation with electronic health record note and advance care planning billing. This will also include: pharmacy review of medications, case management review, and coding specialist review.

Locations

Country	Name	City	State
United States	Duke University	Durham	North Carolina

Sponsors (1)

Lead Sponsor	Collaborator
Duke University

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Proportion of patients who have advanced care planning notes completed during the admission	As measured by medical record review (Pre-implementation)	Hospital admission, up to 7 days
Primary	Proportion of patients who have advanced care planning notes completed during the admission	As measured by medical record review (Post-implementation)	Hospital admission, up to 7 days
Secondary	Proportion of patient who have documentation utilizing the electronic health record dotphrase note template	As measured by medical record review (Pre-implementation)	Hospital admission, up to 7 days
Secondary	Proportion of patient who have documentation utilizing the electronic health record dotphrase note template	As measured by medical record review (Post-implementation)	Hospital admission, up to 7 days
Secondary	Proportion of patients who are billed for advanced care planning	As measured by medical record review (Pre-implementation)	Hospital admission, up to 7 days
Secondary	Proportion of patients who are billed for advanced care planning	As measured by medical record review (Post-implementation)	Hospital admission, up to 7 days
Secondary	Proportion of patients who receive palliative care consults	As measured by medical record review (Pre-implementation)	Hospital admission, up to 7 days
Secondary	Proportion of patients who receive palliative care consults	As measured by medical record review (Post-implementation)	Hospital admission, up to 7 days
Secondary	Proportion of patients who are discharged to hospice	As measured by medical record review (Pre-implementation)	Hospital discharge, up to 7 days
Secondary	Proportion of patients who are discharged to hospice	As measured by medical record review (Post-implementation)	Hospital discharge, up to 7 days
Secondary	Proportion of patients who have an appointment to the palliative care clinic	As measured by medical record review (Pre-implementation)	Up to 1 month
Secondary	Proportion of patients who have an appointment to the palliative care clinic	As measured by medical record review (Post-implementation)	Up to 1 month