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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
709
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).
Perelman Center for Advanced Medicine
Philadelphia, Pennsylvania, United States
Acute care days
number of hospitalization days in the University of Pennsylvania Health System
Time frame: 6-12 months
Mortality
number of patient deaths after enrollment in AHCAH
Time frame: 6-12 months
Hospice enrollment
number of patients who transition from AHCAH to hospice
Time frame: 6-12 months
hospice length of service
If transitioned to hospice from AHCAH, number of days on hospice
Time frame: 6-12 months
University of Pennsylvania Health System total acute care cost
cost of emergency department visit and/or hospitalization within the UPHS Health system
Time frame: 6-12 months
Pennsylvania total acute care cost
cost of emergency department visit and/or hospitalization within Pennsylvania
Time frame: 6-12 months
University of Pennsylvania Health System number of intensive care unit days
number of days hospitalized in an intensive care unit within UPHS
Time frame: 6-12 months
Pennsylvania number of intensive care unit days
number of days hospitalized in an intensive care unit within hospitals in Pennsylvania
Time frame: 6-12 months
University of Pennsylvania Health System emergency department visits
number of emergency department visits within UPHS
Time frame: 6-12 months
Pennsylvania emergency department visits
number of emergency department visits within hospitals in Pennsylvania
Time frame: 6-12 months
Use of intravenous diuretics at home
Prescription and delivery of intravenous diuretics from Penn Home Infusion Therapy Services and administration of intravenous diuretics by AHCAH nurse
Time frame: 6-12 months
new documentation of goals of care
Advance Care Planning documentation within electronic medical record
Time frame: 6-12 months
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