Randomized Trial of a Home-Advance Care Planning Video Intervention for Patients with Life-limiting Illness

项目摘要/摘要 概述：本研究的目标是论证以家庭为基础的提前护理计划的有效性 (ACP)用于改善ACP对话、复苏首选项文档、临终关怀的视频干预 在家庭环境中接受护理的限制生命疾病患者的护理费用。 背景：患有严重慢性病并通过以下途径接受居家护理的患者数量 联邦医疗保险的出诊服务提供者计划正在增加。通常情况下，这些患者缺乏特殊的姑息疗法。 护理和太频繁地接受住院姑息治疗会诊在疾病轨迹的后期。很大一份 在这些住院的特殊姑息治疗咨询中，专门专注于支持非加太计划的文件，以及 满足这一群体的临终(EOL)护理需求。医疗保健系统需要循证的AP- 在家中推广这些重点姑息护理服务的人，同时克服挑战，如 姑息治疗劳动力短缺。我们开发了一种视频辅助、基于家庭的ACP干预(Home- ACP)，以改善患者与临床医生的沟通，增加ACP文档，并导致更多以患者为中心的 在EOL提供更廉价的医疗服务。Home-ACP结合了两个基于证据的功能，包括1)预测性 分析以确定患有晚期严重疾病且预计预后为一年或更短时间的患者；以及 2)由一名护士提供的ACP视频决策帮助，作为三叶草健康的出诊提供者计划的一部分。我们的 之前的工作已经在几个随机试验中显示了ACP视频的有效性，但还没有检查它们的效果 在家里的环境中。这段视频有25种语言版本，并以低识字水平编写脚本。 研究计划：我们建议进行一项家庭-ACP干预与常规干预的随机临床试验 500名患有限制生命的疾病且预后在一年或更短时间内的患者接受家庭护理。我们 将评估Home-ACP对复苏偏好的干预的有效性，ACP文件- 和临终关怀服务的利用。我们还将比较200名患者子集的患者报告结果，包括 ACP知识、对未来护理的信心、沟通满意度和决策确定性。最后，我们将 比较接受Home-ACP干预的患者在生命最后一年的护理成本与平时 关心。 环境：该项目将在三叶草健康之家呼叫提供商的支持下进行- GRAM，它拥有资源、基础设施和电子健康记录能力，以确保 这场审判。患者将从新泽西州17个种族和种族多样性很大的县招募。 调查性研究团队拥有开发和测试视频决策辅助工具和姑息疗法的专业知识 大型多点国家试验中的护理干预。 研究的相关性：该项目将为未来的实施和传播奠定基础 务实的试验包括全国各地数以万计的患者参加电话咨询服务项目。

PROJECT SUMMARY/ABSTRACT Overview: The goal of this study is to demonstrate the effectiveness of a home-based advance care planning (ACP) video intervention for improving ACP conversations, resuscitation preference documentation, hospice utilization, and reducing cost of care for patients with life-limiting illness receiving care in the home setting. Background: The number of patients living with serious chronic illness and receiving home-based care through Medicare's House Call Providers program is increasing. Often, these patients lack exposure to specialty palliative care and too frequently receive inpatient palliative care consultations late in the illness trajectory. A large portion of these inpatient specialty palliative care consults are focused exclusively to support ACP documentation, and addressing end-of-life (EOL) care needs for this population. Health care systems require evidence-based ap- proaches that promote these focused palliative care services at home while surmounting challenges such as palliative care workforce shortage. We have developed a video-assisted, home-based ACP intervention (Home- ACP) to improve patient-clinician communication, increase ACP documentation, and lead to more patient-cen- tered and less costly care at the EOL. Home-ACP combines two evidence-based features including 1) predictive analytics to identify patients with an advanced serious illness and a projected prognosis of one year or less; and 2) ACP video decision aid delivered by a nurse as part of Clover Health's House Call Provider program. Our prior work has shown the efficacy of ACP videos in several randomized trials, but have not examined their effect in the home setting. The video is available in 25 languages and scripted at a low literacy level. Research Plan: We propose to conduct a randomized clinical trial of the Home-ACP intervention versus usual care in 500 patients with life-limiting illness and a prognosis of one year or less, receiving home-based care. We will assess the effectiveness of the Home-ACP intervention for preferences for resuscitation, ACP documenta- tion, and hospice utilization. We will also compare patient-reported outcomes in a subset of 200 patients including ACP knowledge, confidence in future care, communication satisfaction, and decisional certainty. Lastly, we will compare the cost of care in the last year of life for patients receiving the Home-ACP intervention versus usual care. Environment: This project will be conducted with the support of the Clover Health House Call Providers pro- gram, which has the resources, infrastructure, and electronic health record capabilities to ensure the success of this trial. Patients will be recruited from 17 counties in New Jersey with substantial ethnic and racial diversity. The investigative research team has the expertise in developing and testing video decision aids and palliative care interventions in large multi-site national trials. Relevance of Research: This project will establish the foundation of a future implementation and dissemination pragmatic trial including tens of thousands of patients in House Call Provider programs across the country.