Hopewell Hospitalist is a theory-based adventure video game designed to increase the likelihood that a physician will engage in an advance care planning (ACP) conversation with a patient over the age of 65. Drawing on the theory of narrative engagement, players assume the persona of a hospitalist physician and navigate a series of clinical encounters with seriously-ill patients over the age of 65. Players experience the consequences of having (or not having) ACP conversations in a timely fashion. The planned study is a crossover phase III trial testing the effectiveness of providing physicians with a link to a free version of Hopewell Hospitalist as a means for increasing ACP rates measured by ACP billing frequency.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
1,261
Hopewell Hospitalist is a customized theory-based adventure video game that uses narrative engagement to educate physician players on advance care planning to increase physicians' likelihood of engaging in and billing for ACP conversations.
Dartmouth Hitchcock Medical Center
Lebanon, New Hampshire, United States
Incidence of Billed Advance Care Planning
Change in physician advance care planning billing for patients over the age of 65 in the three months before and after the roll-out of the video game intervention at their hospital. Advance care planning billing is defined as the presence/absence of ACP charges (Medicare billing codes 99497 or 99498) during a physician's patient's hospitalization.
Time frame: 6 months (3 months pre and 3 months post intervention)
Merit-based Incentive Payment System Advance Care Planning Quality Score
Change in the Merit-based Incentive Payment System (MIPS) self-report measure of advance care planning by enrolled hospitalists (MiPS-ACP quality score). The MiPS-ACP quality score is the percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. The quality score ranges from 0-100%, with higher scores indicating that a greater proportion of patients with an advance care plan documented in the medical record.
Time frame: 6 months (3 months pre and 3 months post intervention)
Hospitalist-Managed Patient In-Hospital Mortality Rate
In-hospital mortality rate for patients managed by enrolled hospitalists.
Time frame: 6 months (3 months pre and 3 months post intervention)
Hospitalist-Managed Patient 90-Day Mortality Rate
90-day mortality rate for patients managed by enrolled hospitalists.
Time frame: 6 months (3 months pre and 3 months post intervention)
Sum of Resources Utilized by Hospitalist-Managed Patients
Combined sum of resources utilized by patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention). It is a composite measure including: admission to ICU, receipt of life-sustaining treatment(s) including mechanical ventilation, placement of tracheostomy, insertion of gastric feeding tube, new onset dialysis. This measure ranges from 0 to 5, where higher scores indicate greater utilization of resources during the index hospitalization.
Time frame: 6 months (3 months pre and 3 months post intervention)
Incidence of Hospitalist-Managed Patient Admission to ICU
Incidence of admission to ICU for patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
Time frame: 6 months (3 months pre and 3 months post intervention)
Incidence of Hospitalist-Managed Patient Mechanical Ventilation
Incidence of mechanical ventilation of patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
Time frame: 6 months (3 months pre and 3 months post intervention)
Incidence of Hospitalist-Managed Patient Receipt of Life-Sustaining Treatment(s)
Incidence of placement of tracheostomy, insertion of gastric feeding tube, new onset dialysis for patients managed by enrolled hospitalists during their index hospitalization (first hospitalization in the relevant period: control or intervention).
Time frame: 6 months (3 months pre and 3 months post intervention)
Hospitalist-Managed Patient Length of Stay
Total days between admission and discharge for patients managed by enrolled hospitalists.
Time frame: 6 months (3 months pre and 3 months post intervention)
Hospitalist-Managed Patient Disposition Status Type
Type of status upon discharge of patients managed by enrolled hospitalists (e.g., discharged to home, to skilled nursing, to hospice, deceased, etc.).
Time frame: 6 months (3 months pre and 3 months post intervention)
Hospitalist-Managed Patient 90-Day Episode-Based Spending
Amount of total Medicare payments between index admission and 90-days for patients managed by enrolled hospitalists.
Time frame: 6 months (3 months pre and 3 months post intervention)
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